Physiotherapists contracted with WorkSafeBC for concussion and vestibular physiotherapy (CVPT) use this seven-page report for the initial assessment or a reassessment. It records concussion criteria based on the American Congress of Rehabilitation Medicine, symptoms and history, outcome measures, neurological and cervical screens, a vestibular ocular-motor screen, balance testing, job match, and the treatment goals, visits and expected outcome.
The contracted CVPT physical therapist completes the whole report, including attempts to contact the employer, and records whether the plan has been communicated to the claim owner.
Download the current version from the source each time; forms change without notice.
Concussion and Vestibular Physiotherapy (CVPT) Assessment Report
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The subjective findings table is based on the American Congress of Rehabilitation Medicine criteria for concussion. It asks whether there was loss of consciousness (and whether it was witnessed), memory loss for events immediately before or after the injury, altered mental state at the time, and any focal neurological deficit.
The report asks whether regular or modified duties can be performed alongside physiotherapy based on current functional abilities and, if not, when they could begin. It matches each essential job duty against the worker's measured functional ability and asks for recommended modified hours or duties.