When CNESST asks for an occupational therapy report on a worker being treated after an employment injury, the treating occupational therapist must use this four-page form. It covers the worker's perceptions and pain ratings, objective findings and functional data at the initial and current state, the therapist's opinion on return to work, the treatment plan and whether treatment should end.
The occupational therapist, a member of the Ordre des ergothérapeutes du Québec, completes and signs the whole report, including the supplier number, member number and the treating professional's prescription details.
Download the current version from the source each time; forms change without notice.
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
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Within 15 days of CNESST's request; the request date goes at the top of the form. The explanatory notes say that if CNESST has not received the report by then, payment for treatments is suspended, except for public health establishments. Send it to CNESST and copy the treating health professional.
Yes, when CNESST requests it. CNESST's page says occupational therapists treating a worker with an employment injury must use and complete this form when CNESST asks for an occupational therapy report, and the notes say providers must send it using this template. IVAC also uses the form for crime victims.
No. The form's notes state that the report serves as the invoice and that the provider cannot claim any amount from the worker, citing section 194 of the LATMP. CNESST pays for the report and for the occupational therapy treatment it covers.