Initial Worker Interview
WoRK BC Mental Health Adjudication

Instructions: This form is completed by Senior Adjudicators while interviewing a worker with a mental
health claim. Conversational prompts (/ike this) are provided to support the gathering of information; please
ensure all prompts are removed prior to the form being finalized.

Worker's information

Worker's last name First name Middle initial | WorkSafeBC claim
HOLAND MARK number
42647461

Employment information
Occupation (job title)

Relief Control Operator (training position)

Employer and Worksite location Duration of employment and full time or part time

BC Rapid Transit Co Ltd - 6800 14th Full time since January 12, 2026 (W was in rail maintenance for
Ave, Burnaby prior 2.5 years)

Has your employer been advised of If yes, to whom was it reported?

your current condition? (yes/no) | Yes, Ronald Wainwright

Yes

|
Do you have any other employers? (yes/no)
No

Additional Information, including manager’s and/or supervisor’s contact number

Job Demands
e First 3 weeks are classroom training sessions
e W was still in training for position

Time loss information (if applicable)
Last day worked: January 22, 2026
First shift missed: January 26, 2026

RTW: January 27, 2026 (W completed the classroom portion of the course then took the rest of the day off
on January 29, 2026 and has yet to return)

Payee: Some sick days

Incidents

Include complete details for one or multiple incidents.

e Things started with ear pain

e Stress of completing the course and being ignored by safety caused him a break down

e W moved from rail maintenance to control training room

e W was sat in the back and there was loud server fan type machines which made a loud noise
e Less than 85 dB

e On jan 22, 2026, W started having ear pain

e On Jan 25, 2026, W went to Royal Columbian

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