WorkSafeBC may refer a worker whose injury affects their ability to perform work tasks to its contracted Functional Capacity Evaluation network, and the assessor reports results on this Word template. It covers 1-day and 2-day FCEs, functional screen evaluations, 1-day and 2-day Cognitive FCEs and incomplete assessments. Each tested demand is rated against the worker's job as a match, no match or inconclusive.
The contracted FCE or Cognitive FCE assessor completes the whole report and records their name and professional designation(s), while the provider company adds its payee number and contact details. The referral questions it must answer come from the WorkSafeBC officer.
Download the current version from the source each time; forms change without notice.
Functional Capacity Evaluation (FCE) or Cognitive Functional Capacity Evaluation (Cognitive FCE) Report
This form is a Word template, not a PDF. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.
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The template states that the report is due within 5 business days of completing the assessment. It also records the date the referral was acknowledged, the Day 1 assessment date, the completion date and the start and end times of each assessment day, and asks whether a job demands analysis was done with a site visit.
Yes. One template covers standard and Cognitive FCEs. Strength and physical demand rows, such as lifts, carries, grip strength, reaching, kneeling and walking, apply to both, and the cognitive demands table is kept only for a Cognitive FCE, which WorkSafeBC describes as evaluating cognitive and physical abilities.
The Copies to section notes that, at minimum, a copy should always go to WorkSafeBC and to the primary care provider, such as the attending physician or nurse practitioner. Other recipients can be added. Detailed test data, including trials, repetitions, weights, increments and forces, goes in the appendix.