Initial, progress or discharge report for clinic-based occupational rehabilitation (CBOR) of a worker.
- Completed by
- Attending licensed practitioner at a clinic-based occupational rehabilitation provider
- Issued by
- WorkplaceNL
- Format
- Language
- English
WorkplaceNL Form OR: OR Report Information Sheet
Occupational rehabilitation providers attach this one-page sheet, printed as Occupational Rehabilitation Services Report Information, to the reports they send WorkplaceNL. It identifies the worker's claim, the vendor, the licensed practitioner, the purchase order, the date of service and the number of pages in the report. Tick boxes show which service the report covers, from a job site analysis to worksite occupational rehabilitation.
Who completes it
The occupational rehabilitation vendor or practitioner who delivered the service completes the whole sheet, including the licensed practitioner's name and identifier number. Under Policy HC-12, a licensed practitioner is a fully licensed occupational therapist or physiotherapist practising occupational rehabilitation in Newfoundland and Labrador.
Submitting and payment
- How to submit it
- The sheet is marked send by fax only, but WorkplaceNL's occupational rehabilitation page says providers can now submit reports such as job site analyses, functional assessments and WSOR reports online through MyWorkplaceNL.
- Who pays
- WorkplaceNL sets the reporting requirements and fees for the occupational rehabilitation services it refers (Policy HC-12), and the sheet records the purchase order number for the service.
Good to know
- Service boxes cover JSA (job site analysis), WSR (work station review), FA (functional assessment), ADJ. ASSESS (adjudication assessment), WSOR (worksite occupational rehabilitation), PRFI and other services, plus onsite visit, documentation and consultation.
- WorkplaceNL covers occupational rehabilitation when it makes the referral, a licensed practitioner provides or supervises the service, and the clinic has signed a Memorandum of Agreement (Policy HC-12).
- Policy HC-12 requires a licensed practitioner to complete work station reviews and adjudication assessments and to interpret functional assessment data; trained non-licensed staff may do job site analyses.
- Clinic-based occupational rehabilitation (CBOR) is not one of the sheet's service boxes; WorkplaceNL handles CBOR through a separate clinic-based reporting form and online CBOR reports.
Get the official form
Download the current version from the source each time; forms change without notice.
OR Report Information
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.
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
What is WorkplaceNL Form OR used for?
It is the information sheet sent with an occupational rehabilitation report. It records the worker's surname, given names and claim number, the vendor's name and number, the licensed practitioner's name and identifier number, the PO number, the date the service was rendered, the number of pages in the report and which service the report covers.
Can occupational rehabilitation reports go to WorkplaceNL online?
Yes. Form OR is printed 'send by fax only', but WorkplaceNL's occupational rehabilitation page says providers and clinic administrators can submit documents and reports at MyWorkplaceNL, including job site analyses, work station reviews, functional assessments, worksite occupational rehabilitation, adjudication assessments and PRFI, and review their submission history there.
Who counts as a licensed practitioner on Form OR?
Policy HC-12 defines a licensed practitioner of occupational rehabilitation as a fully licensed occupational therapist or physiotherapist practising in occupational rehabilitation and regulated in Newfoundland and Labrador. Non-licensed staff may deliver some services under that practitioner's supervision, and every service must be directed and monitored by an experienced licensed practitioner.