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SAAQ 7012-30: Aide personnelle, grille ergothérapeutes

Quebec occupational therapists use this five-page French grid to assess a road accident victim's need for personal assistance, and the SAAQ uses it to set the indemnity the person is entitled to for help at home. It covers the pre-accident functional profile, the profile for the period assessed, and a rated evaluation of 35 daily activities.

Who completes it

The occupational therapist completes and signs the whole grid with their licence number. The accident victim signs the Déclaration section of the separate fee form 6137-30 that accompanies it.

Submitting and payment

How to submit it
The SAAQ's OT page says to print the grid, fill it in by hand, sign it and fax it to the SAAQ. The form itself also lists the SAAQ's online document service and mail, and says to keep the original or a copy.
Who pays
The occupational therapist claims professional fees on form 6137-30, Frais de services professionnels, Aide personnelle, sent together with the grid.

Good to know

  • Each activity is rated from autonomous (a) to totally dependent (d), with codes for verbal cues, physical help, supervision, not assessed and not applicable, plus an Observed box.
  • Only the victim's own needs count; the needs of other people living in the same home are not covered for personal assistance.
  • The SAAQ says needs must be foreseeable, significant and regular, and assessed where possible through objective evidence such as simulated tasks or direct observation.
  • The revised grid can be used whatever the accident date and applicable scale, and any additional report attached is considered in the needs analysis.

Get the official form

Download the current version from the source each time; forms change without notice.

Aide personnelle – Grille à l'usage des ergothérapeutes

Personal Assistance – Grid for Occupational Therapists

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it 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.

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How this list is checked

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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Frequently asked questions

Is the SAAQ 7012-30 grid available in English?

No. The SAAQ publishes the Aide personnelle grid for occupational therapists in French only, as a five-page PDF dated 2016-05. Its OT page describes printing the grid, completing it by hand and signing it before sending it to the SAAQ.

What does Section 1 of the grid cover?

Section 1, the pre-accident functional profile, is completed only at the first assessment. It records prior impairments and limitations, hand dominance, home services and assistive devices in place before the accident, whether the person drove, usual transport, and their usual productive, sedentary and active leisure activities.

Why describe a typical day on the grid?

For free time and night-time supervision needs, the grid asks for recent situations and how often the person was at risk. It suggests attaching a description of a typical day if needed, and warns that without this information the SAAQ's analysis will be compromised.