The Report of Work Ability must either be on this form or in a report that contains the same information.
Options: the employee is able to work without restrictions, able to work with restrictions, or unable to work.
Restrictions: if the employee is able to work with restrictions, fill in the date any restriction of work activity is to begin and the anticipated ending or review date.
Copy: the health care provider must provide the Report of Work Ability to the employee and place a copy in the medical record.
Employee: must promptly provide a copy of this report to the employer or workers' compensation insurer, and qualified rehabilitation consultant if the employee has one.
| Question | Answer |
|---|---|
| Form Name | Form RW01 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 28 |
| Avg. time to fill out | 5 min |
| Edition | 5/17 |
| Matches the agency's file | Yes, checked October 3, 2026 |
| Other names | RW01, RW-01, MN RW01, Form RW01, Report of Work Ability, Work Ability Form |
| Official source | Form RW01 (Rev 5/17), Minnesota Department of Labor and Industry |
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