Last updated: 10/1/2025
Reemployment Eligibility Evaluation Checklist {Form 07-6150}
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Description
Form 07-6150 - ELIGIBILITY EVALUATION CHECKLIST (Date of Injury January 01, 2025, or after). This The Alaska Reemployment Benefits Section form is completed by the assigned rehabilitation specialist (RS) to support the eligibility evaluation report for injuries on/after 01/01/2025. The one-page checklist gathers employee, employer, and insurer details; summarizes the job at injury and prior jobs/training; notes any offer of alternative employment (attach signed OAE); and records physician review of O*NET job descriptions using the 1993 SCODRDOT crosswalk plus documentation that PPI > 0% is anticipated or assigned at medical stability. It also captures data for the RBA’s annual report under AS 23.30.041(b), requires itemized billing per 8 AAC 45.500(b), and includes a Proof of Service to the employee, insurer, RBA, and counsel. www.FormsWorkdlow.com
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