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Occupational Medicine Specialist Form

CNESST Rapport d’Évaluation Médicale (Form 2064)

A downloadable Occupational Medicine Specialist form for healthcare professionals.
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Specialty

Occupational Medicine Specialist

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Type

Form

Last edited

7/23/2026

Created by

Heidi Team

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About this form

Designed for healthcare professionals managing workplace injuries under Quebec’s Commission des normes, de l’équité, de la santé et de la sécurité du travail (CNESST), this report supports the comprehensive medical assessment of permanent impairments and functional limitations following a work-related injury or occupational disease. It captures the worker’s diagnosis, current symptoms, relevant medical history, therapeutic interventions, physical or mental examination findings, diagnostic investigations, functional limitations, recommendations for further specialist assessment, and conclusions. The report also documents permanent sequelae and impairment ratings to assist the CNESST in determining permanent disability and work capacity. Heidi helps clinicians efficiently generate structured medical evaluation reports that support accurate occupational health assessments, claims management, and return-to-work planning.

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