Non-specialist physician's combined first report and invoice for every first visit on a work injury.
- Completed by
- Physician (general practitioner / non-specialist)
- Issued by
- WCB-Alberta
- Format
- Online portal or EMR
- Language
- English
WCB Alberta C942: Opioid Risk Assessment Checklist
Physicians use this two-page checklist when considering opioid therapy for a worker on a WCB-Alberta claim. Page 1 screens for contraindications, past problems with drugs or alcohol and CAGE-AID responses, then records the Opioid Risk Tool score and how well the physician knows the patient. Page 2 is the Opioid Risk Tool worksheet, marked not for the WCB claim file.
Who completes it
The prescribing physician completes, scores and signs the checklist with the patient, including the Opioid Risk Tool worksheet on the reverse, whose total is transferred to page 1.
Submitting and payment
- How to submit it
- Fax or mail page 1 to WCB-Alberta using the details printed on the form; the Opioid Risk Tool worksheet on page 2 is marked not for the WCB claim file.
Good to know
- Contraindications listed include acute psychiatric instability, respiratory depression, suspected GI obstruction, substance or opioid use disorder, pregnancy or breastfeeding, long QT, hepatic failure and CYP3A4/CYP2D6 inhibitors.
- CAGE-AID screening counts as positive with two yes answers for males or one yes answer for females.
- Opioid Risk Tool totals are banded as low risk (0 to 3), moderate risk (4 to 7) and high risk (8 and above).
- The Opioid Risk Tool on the form comes from Appendix B-2 of the 2010 Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain.
Get the official form
Download the current version from the source each time; forms change without notice.
Opioid risk assessment checklist (C942)
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.
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
Does the Opioid Risk Tool worksheet go to WCB?
No. Page 2 of C942, the Opioid Risk Tool worksheet, is marked not for the WCB claim file. The prescribing physician scores it and transfers only the total score and risk category to page 1, which also records the contraindications, CAGE-AID answers, the physician's signature and WCB billing number.
When is the C942 checklist used?
WCB-Alberta lists it under opioid management for physicians, with the opioid treatment agreement (C913) and medication management report (C914). Page 1 is headed contraindications for initiation of opioid therapy, so it screens risk when opioids are being started; WCB policy also expects an adequate trial of non-opioid analgesics first.