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Yukon WSCB Psychological Initial Assessment (F-0077)

Psychologists assessing a Yukon worker for a work-related psychological injury report their findings to WSCB on this four-page form. It covers sources of information, family, trauma and mental health history, education and work, leisure and supports, and general observations, then clinical scale T-scores, test findings, a summary with recommendations and a DSM diagnosis. Policy 3.16 requires the written report within two days of the initial assessment.

Who completes it

The assessing psychologist completes and signs all four pages. A Psychological Functional Abilities Form (F-0071) goes with it, and the worker receives a copy of that form to share with the employer.

Submitting and payment

How to submit it
Send it to WSCB by fax or mail within two days of the initial assessment, together with the functional abilities form, and share it with the worker's family physician as policy 3.16 expects.
Who pays
WSCB normally pays for psychological services only once the claim is accepted and the treatment authorized, under the service agreement providers must sign before providing care.

Good to know

  • Page 3 tabulates T-scores and interpretations for 15 clinical scales, including depression, intrusive experiences, hyperarousal, dissociation, anger and suicidality (ideation and behaviour).
  • If you make no DSM diagnosis, the form asks whether a DSM diagnosis was considered and ruled out.
  • A psychological injury must be accepted under policy 2.4 before WSCB normally funds treatment; after a serious workplace incident or fatality, its President may approve early intervention.
  • Where evidence conflicts or the provider recommends it, WSCB may order an independent psychological assessment, since diagnosing and treating the same worker can create a conflict of interest.

Get the official form

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

Psychological initial assessment report

Official pagePDF

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Frequently asked questions

How soon is the Yukon psychological initial assessment report due?

Within two days of the initial assessment. WSCB policy 3.16 requires service providers to submit a written report outlining their assessment of the injury, the diagnosis and a treatment plan in that time, together with a Functional Abilities Form for psychological injuries (F-0071).

Will WSCB pay for a psychological assessment before the claim is accepted?

Under normal circumstances, no. Policy 3.16 says the board will not authorize payment for psychological services before a claim is accepted. The exception is early intervention: after a serious incident or fatality in a workplace, WSCB may authorize immediate counselling and crisis services, approved by its President, even before a claim is filed.

What history does F-0077 ask for?

Pages 1 and 2 ask for your sources of information, family history, trauma and mental health history, education and work, leisure and supports, and general observations. Page 3 records the psychological tests administered with their findings and the clinical scale T-scores, and page 4 gives the summary, recommendations and DSM diagnosis.