WorkSafeNB uses the Initial Psychology Assessment Report to decide whether a worker's psychological injury meets the requirements for acceptance under the Workers' Compensation Act, and as a baseline for recovery if it does. The fillable Word template covers the workplace event from both worker and employer, symptoms, history, psychometric testing, diagnostic formulation, risk, barriers and functional abilities.
The assessing psychologist, social worker or counselling therapist completes the whole template, including their WorkSafeNB provider number. The employer's account comes from the Report of Accident or Occupational Disease (Form 67) sent with the referral, and the worker completes the separate Mental Health Questionnaire.
Download the current version from the source each time; forms change without notice.
Initial Psychology Assessment Report
Service psychologique – Rapport d'évaluation initiale
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.
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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The 2026 template says to submit within 5 business days of completing the assessment and not to start treatment without WorkSafeNB's prior approval. MyServices is the recommended channel, and reports sent through it need no signature because the log-in serves as identification.
The template has rows for the PHQ-9, GAD-7, PCL-5 when post-traumatic symptoms are indicated, and the B-IPF for function, plus personality testing and self-report validity indicators. WorkSafeNB's instructions ask for descriptive labels or normative comparisons rather than raw scores.
Yes. WorkSafeNB posts a French Word version, Service psychologique, Rapport d'évaluation initiale, on its French-language site. Both are fillable Word documents, and WorkSafeNB notes that the boxes adjust to the amount of text you enter.