WoRK BC Initial Worker Interview
Mental Health Adjudication

Worker's last name First name Middle initial WorkSafeBC claim number

HOLAND MARK 42647461

e W has been having migraines since age 4 (no diagnosis)

e  Triggers-noise pollution (noise cancelling headphones), stress, alcohol, cold, light
Smoking

e W smoked on and off since age 18, go through spurts where he quits

e Nicotine gum as replacement

e W was about a pack a week smoker prior to this
W thinks this might be associated with

Next Steps

e CIR referral request
e W believes tonal quality of the sound is causing the issues

68B138 (24/09) Page 6 of 6