California Division of Workers’ Compensation
To document the findings and recommendations of the Qualified Rehabilitation
Representative who conducts the initial evaluation. Per AR §10132.1, such assessment
is to include an initial assessment of the worker’s ability to benefit from VR services.
Qualified Rehabilitation Representative (QRR).
The Rehabilitation Unit encourages an expeditious assessment of employee skills and
vocational feasibility. The RU-120 should be submitted not later than 30 days from
completion of the initial interview unless otherwise agreed to.
To the claims administrator with copies to all parties. If the QRR is functioning as an
Independent Vocational Evaluator (IVE), the RU-120 would be filed directly with the
Rehabilitation Unit with copies to all parties.
This form is to be completed by the QRR. The purpose of the form is to obtain
comprehensive, yet concise, information which is critical for assessing vocational
feasibility and developing an appropriate plan per the California Standards Governing
Timeliness and Quality of Vocational Rehabilitation Services. Information gathered for
each section must fit within the section designated for that category and the typeface
must be no smaller than 10 point. The cost of additional or more detailed reports shall
be borne by the party requesting them.
Rehabilitation Unit action:
INITIAL EVALUATION SUMMARY
Date of Initial Evaluation:
Reason for Referral:
Initial Meeting and Impressions: Vocationally Feasible? Yes No