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WorkplaceNL Initial Counselling Report

A counsellor sends this five-page report to WorkplaceNL after the first session with a worker referred for counselling on a claim. It covers the presenting problem and treatment to date, any DSM diagnosis with psychometric results, medications and substance use, suicide risk, a treatment plan with the expected number of sessions, and the worker's return-to-work outlook. Its companion is the Counselling Progress Report.

Who completes it

A counsellor with a WorkplaceNL vendor number, such as a psychologist or social worker, completes every section and signs and dates the last page. There is no worker or employer section; the counsellor records the worker's details, claim number, referral date and date of injury.

Submitting and payment

How to submit it
Fax the completed report to WorkplaceNL at the number printed at the top of page one.
Who pays
The report identifies you by WorkplaceNL vendor number, and registered health care providers and vendors view purchase orders, submit invoices and see payment information through WorkplaceNL's supplier portal.

Good to know

  • Psychosocial measures linked to the current DSM diagnosis go in a table of tool, normal range, and results and interpretation; the form gives PCL-5 and the Trauma Recovery Scale as examples.
  • Suicide risk is rated no risk, low, medium or high, and any identified risk needs risk and protective factors plus a risk management plan where required.
  • The treatment plan asks for the expected total number of sessions, weekly, bi-weekly or other frequency, planned modalities and interventions, and any referral needed, such as psychiatry or OT support.
  • The form also asks about pre-existing mental health conditions, including any earlier DSM diagnosis and the treatment or status the worker reports.

Get the official form

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

Initial Counselling Report

Official pagePDF

Fill it with Vero

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.

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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

Who can complete WorkplaceNL's Initial Counselling Report?

A counsellor who has a WorkplaceNL vendor number, such as a psychologist or social worker. The health professional section asks for the counsellor's name, vendor number and telephone number, and the final page carries the counsellor's name, signature and date. The worker and employer do not complete any part of it.

What return-to-work details does the counselling report ask for?

Whether the worker can return with no restrictions, or with restrictions and supports, and an explanation if they cannot return in any capacity. If there are restrictions, you say whether you recommend an occupational therapy assessment. You also describe barriers in presentation, functioning or affect, and the worker's confidence and desire to return to or stay at work.

Can counselling on a WorkplaceNL claim be delivered virtually?

The report records service delivery as in-person, virtual or a combination of both. Alongside that it captures the referral date, the date of the initial counselling session and the report completion date, as well as the worker's date of injury and WorkplaceNL claim number.