Industrial Medical Council Course Evaluation
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Industrial Medical Council Course Evaluation Form. This is a California form and can be use in General Workers Comp.
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Tags: Industrial Medical Council Course Evaluation, IMC-117, California Workers Comp, General
STATE OF CALIFORNIA
Arnold Schwarzenegger, Governor
DEPARTMENT OF INDUSTRIAL RELATIONS
INDUSTRIAL MEDICAL COUNCIL
DWC - Medical Unit
P.O. Box 420603
San Francisco, CA 94142
Tel. No.: (650) 737-2700 or 1-(800) 794-6900
Fax No.: (650) 737-2711
INDUSTRIAL MEDICAL COUNCIL COURSE EVALUATION
As a part of the IMC's ongoing efforts to ensure that courses for Qualified Medical Evaluators offer
valuable information on California Workers' Compensation-related medical evaluation issues,
we are asking attendees of the IMC approved courses (including distance learning programs) to
complete the following Course Evaluation.
Date of Course:
Course Provider:
Maximum Course Hours Available
Hours Completed
Excellent
Good
Satisfactory
Fair
Poor
Content of Hand-out material
5
4
3
2
1
Accurate/Adequate new information
5
4
3
2
1
Educational Objective Met
5
4
3
2
1
Pertinence to QME evaluations
5
4
3
2
1
Knowledge of presenters
5
4
3
2
1
Syllabus Legibility
5
4
3
2
1
Adequacy of Room
5
4
3
2
1
Adequacy of Audio Visual
5
4
3
2
1
Overall Rating
5
4
3
2
1
What improvement(s) would you suggest?
TO ALL ATTENDEES: PLEASE RETURN THIS FORM TO THE IMC.
All providers shall be required to provide this response form (postage paid) to all attendees and shall
advise all attendees that the form should be promptly returned to the IMC at the address on the back
of this form.
IMC Form 117, Rev. 3/01/00
Note: Authority Cited:
Reference:
Section 139.2, Labor Code.
Section 139.2, Labor Code
IMC Regs-Form
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