cumulative record of skills - tasn · cumulative record of skills 1. vocational skills - clerical:...

1

Cumulative Record of Skills 1. Vocational Skills - Clerical: Make sure to list the locations where each item was assessed. If more than one location is used, you may need to use a separate sheet for each location. Make a note of the environmental differences or similarities between each location.

Pass Setting and Structure Emerge Setting and Structure

Basic Computer Usage: • Turn on and off correctly • Use mouse • Access internet, find site • Save files • Open files • Note other skills:

Word Processing: • Use of word processor • Note speed and accuracy level • Use different menu commands to change font, make bold,

etc. • Note other skills:

Data Entry: • Use of basic database program • Note speed and accuracy • Note other skills

Typing: • Copies and makes corrections to pre-typed information • Types 15 words per minute • 30 words per minute • 45 words per minute

Filing: • by name • by number (specify length of number sequence) • by combined set of information (i.e. both name and

number)

Sorting by Number: • 1 digit number • 5 digit number • 10 digit number

Student’s Name: ___________________

2

Pass Setting and Structure Emerge Setting and structure Sorting by Letter:

• 1 letter sequence. • 1 word • 2 words

Use of Copier: • Make single one-sided copy • Make multiple one-sided copies • Use sort function • Use collate function • Use staple function • Uses double-sided originals to make double-sided copies • Use single-sided originals to make double-sided copies • Note other skills:

Picking Up and Delivering Materials: (Note details) • from single setting to single setting • from multiple settings to single setting • from single setting to multiple settings • from multiple settings to multiple settings

Collating Various Materials: (Note details) • Letters • Forms • booklets

Mailing: • Folds correctly (bi-fold, tri-fold) • Seals • Apply stamps • Use return address stamp • Apply address labels

Use of Phone Book: • Find names • Use the yellow pages to find vendor or business.

Answering Telephones: • Appropriate greeting • Transfers calls • Take a message, obtains name of caller, telephone

number, date and time, other details (specify method) • Know what to do with unexpected requests

3

Pass Setting and Structure Emerge Setting and Structure Using Phone to Deliver Message/Obtain Information:

• Calls the right number • Asks for correct person • Gives information correctly • Asks for information and records appropriately • Ends conversation appropriately

Cutting: • Use scissors safely and neatly • Follow a line for a complex shape (specify)

Shredding Papers:

Use Rolodex or Address file: • Find names and transfer information

Processing Documents for Electronic Data Storage: • Use of Scanner • Microfilm

Laminating Documents: • Turn on and wait for laminator to warm up • Prepare documents • Cut out object when finished • Other skill:

4

2. Vocational Skills - Domestic: Make sure to list the locations where each item was assessed. If more than one location is used, you may need to use a separate sheet for each location. Make a note of the environmental differences or similarities between each location.


Dusting: • Dust large and small objects • Move items safely on a table to be dusted • Replace items on a table to be dusted

Vacuuming: • Vacuum large and small areas (specify) • Vacuum close to the edges of walls and furniture • Move objects to vacuum under them

Sweeping: • Sweep large and small areas (specify) • Close to the edges of walls and furniture • Move objects to sweep under them • Use the dustpan.

Mopping: • Mop large and small areas (specify) • Close to the edges of walls and furniture • Move objects to mop under them?

Wiping Tables: • Clean the whole table systematically • Remove stubborn dirt (Note method used)

Washing Windows/Mirrors: • Clean the surface leaving it streak free.

Wash Dishes by Hand: (Note method, cleaning utensils, etc.)

Sort Dishes: • Sort into stacks • Sort to cabinet

Empty Trash Sewing:

• Sew buttons • Make simple seam repair • Use sewing machine for repairs • Other skills

5

Pass Setting and Structure Emerge Setting and Structure Identify Areas That Need to be Cleaned Specify

Identify Proper Cleaning Materials for a Specific Task Specify

Washing Machine: • Sort by type of clothes to be washed • Set correct temperature • Use correct amount of detergent. • Load proper amount • Recognize when machine is out of balance and

correct

Dryer: • Set to correct temperature • Clean lint filter • Set timer • Load proper amount.

Laundry: • Fold (specify) • Sort (specify) • Hang on hanger • Other skills:

Sorting/Recycling: • Sort two different types of materials • Sort 3-5 materials • Reject materials that cannot be recycled

Strip/Make Beds Roll Silverware Load Dishwasher Unload Dishwasher

Bathroom Cleaning: • Sink • Toilet • Toilet paper on roll

Setting Table Wears gloves Microwave:

• Use multiple settings • Correctly set timer.

6

Pass Setting and Structure Emerge Setting and structure Food Preparation:

• Gather materials and utensils • Follow a simple recipe • Measure ingredients • Cut • Slice • Mix • Note other skills:

Stove: • Use stove to prepare an item or meal • Use proper settings • Operates safely • Recognizes when food is done (specify how)

Safety Procedures: Note specifics • Sanitation • Machinery

Pot Sink: • Use a three sink systems to wash and sanitize pots

Dishwasher: • Use a household dishwasher • Industrial dishwasher

Identify Clean vs. Dirty Fill Condiments:

• Salt and Pepper, Sugar • Fill prepackaged serving stations

Remove Items from Trays Entering a Dish Room? (Be sure to check during a very busy time)

Cashier: • Ring up items • State cost • Count money received • Return change • Bag items

Serve Food to Others: • Serve correct amount • Take verbal requests • Use proper sanitation

Wears Gloves:

7

3. Vocational Skills – Warehouse/Stocking/Retail: Make sure to list the locations where each item was assessed. If more than one location is used, you may need to use a separate sheet for each location. Make a note of the environmental differences or similarities between each location.

Pass Setting and Structure Emerge Setting and Structure Inventory:

• Identify products • Count • Record on proper sheet

Locating Items in a Store or Warehouse Filling an Order or Use a List to Gather Items Putting Items Away in a Store or Large Facility Blocking (Stacking items on back of shelf) Fronting (Bring items to front of shelf to make it look full) Facing (Turn labels forward) Lifting and Moving:

• Lift 10 pounds and carry 20 feet • Lift 20 pounds and carry 20 feet • Lift 30 pounds and carry 20 feet • Lift 40 or more pounds and carry 20 feet • Specify other lifting and moving skills: • Do they use proper technique?

Labeling/Pricing: • Check to make sure price and label are correct an

match

Stocking/Stacking: • Check items for correct location • Follow store procedure for extra items that cannot be

shelved • Follow store procedure when cannot find matching

items on shelf • Follows store procedure for items that can not be

shelved

Packaging: (specify task, number of items, etc.) • Stacks • Wraps for breakage prevention • Uses packing insulation correctly • Tapes, prepares box for shipment • Addresses box, labels, uses stamps

8

Pass Setting and Structure Emerge Setting and Structure Assembling: (specify task, number of items, etc.)

• Assembles containers (boxes, paper-containers, etc.)

• Assembles materials for shipping/packaging (specify visual structure and materials)

• Completes 2-4 piece assembly task (specify structure that assists assembly: diagram, photo, illustration, picture list)

• Completes 5-8 piece assembly task (specify visual structure)

Taping and Mailing: • Boxes for delivery • Note other skills

Cashier: • Ring up items • State cost • Count money received • Return change • Bag items

Cleans work area after completing a job Categorizes merchandise by season, rotes for display Processes inventory for display:

• Remove bags, pins, packaging, etc. • Hangs clothes for display • Prepares shoes for display • Arranges display according to picture or written

list

9

4. Vocational Skills – Library: Make sure to list the locations where each item was assessed. If more than one location is used, you may need to use a separate sheet for each location. Make a note of the environmental differences or similarities between each location.


Use of Card Catalog and Electronic Catalog to Locate Books. • Search by title • Search by author • Search by category. • Record information for later use.

Scanning Shelves for Books: Note strategy used

Shelving books: • Use Dewey Decimal system • Use Library of Congress system • Discriminate between books that have very similar call

letters

Replace cards in returned books. • Checks them in using electronic system.

Locates/Uses References and Materials

Arranges and organizes periodical/magazine displays/racks

Book Displays • Uses list to pull books for display • Sets up display as directed (following visual)

Makes Inventory List for Materials Ordered/Added to the Library Collection

• Creates written list of new materials • Adds to an electronic list/database of new materials • Scans materials to create an electronic list

10

5. Vocational Skills – Landscaping/Gardening: Make sure to list the locations where each item was assessed. If more than one location is used, you may need to use a separate sheet for each location. Make a note of the environmental differences or similarities between each location.


Water Plants with Watering Can or Hose: • Use correct amount of water (specify method)

Weeding: • Recognize where to weed • Recognize what to weed. • Avoid stepping on plants

Potting Plants: • Transplant seedling to larger pots • Fill with correct amount of dirt • Use of fertilizer • Pack dirt correctly • Put plant at correct depth. • Note other skills

Digging Hole: • Use shovel or spade • Dig to correct depth and width • Refill

Carrying Items: • Shovels • Rakes • Buckets. • Collect items for task

Mowing: • Start mower • Use mower safely • Know where to mow and how to mow • Completes entire area • Use care and operation procedure (gas, oil, blade check,

etc.)

Weed Trimmer: • Start weed trimmer • Know where and how to remove weeds • Use care and operation procedure

11

Pass Setting and structure Emerge Setting and structure Planting/Packaging Seeds:

• Correct number of seeds in hole • Hole at proper depth • Correct amount of water.

Raking Leaves: • Rake entire area (specify size) • Rake completely and neatly (specify size) • Bag and take to correct location

Picking Vegetables: • Identify ripeness • Identify rotten or damaged vegetables • Avoid damaging plant when picking • Package vegetables gently

Trimming Hedges: • Use hand held or electric trimmer • Correctly shapes hedge • Picks up clippings and disposes in waste bin or basket

Flowers: • Identifies different flowers • Collects flowers for bouquet • Trims stems • Removes lower leaves • Places medium in bottom of vase or flower container • Harmonizes colors, shapes, etc. (if using a visual

support, describe) • Places flower stems in vase or watering tube • Adds water to vase or watering tube • Boxes flowers for delivery

Firewood: • Saws firewood • Cleaves firewood • Stacks wood • Packages/bundles wood • Moves wood from one area to another

Sale of Landscape or Gardening Items (see retail checklist)

12

6. Vocational Behaviors: These correspond to the issues related to length of day, ability to attend to details and ability to focus for extended periods of time. Please note the various locations and what was observed. Please list anything that is relevant to the individual that may hinder or improve the ability to work.


Stamina: In “comments” section for each passing score, note tasks that student completes at this pace

• Works at a steady, fast pace for 10 minutes • for 20 minutes • for 30 minutes • for 1 hour • for 1½ hours.

Length of Workday: In “comments” section, note tasks that student completes and what time of day.

• Works for 1 1/2 hours without a break and maintain quality and focus

• Works for 2 hours with a break • Works for 4 hours with one meal break.

Length of Work Week: • Works at least a 3 hour shift 2 days a week maintaining

quality and focus, • Works at least a 3 hour shift 3 days a week, • Works at least a 3 hour shift 4 days a week. • Note tasks or job in “comments” section.

Reports to Work on Time: • Requires personal support to arrive at work on time 90%

of time (define type of support), • Arrives at work on time without personal prompt 90% of

time (define structure needed)

Return from Break on Time: • Requires personal support to return from break on time

90% of time (define type of support), • Returns from work on time independently without

personal prompt 90% of time (identify structure needed

Accepts Supervision: (specify jobs) • Responds to job coach supervision without agitation, • Responds to on site supervisor without agitation, • Responds to multiple supervisors without confusion or

agitation.

13

Pass Setting and Structure Emerge Setting and Structure On Task Ability:

• Stays on task with supervisor or coach in close proximity, • Stays on task with coach across room, • Stays on task with coach in next room.

In “comments” section, note number of minutes and tasks or job.

Transitions within Tasks (stationary vs. mobile): • Completes multi-step tasks that do not require movement

(stationary) consistently without hesitation or repetitious movement,

• Completes multi-step tasks that require movement within a small area (20 sq. ft.) consistently without hesitation or repetitious movement,

• Completes multi-step tasks that require movement within a large room (100 sq. ft.) without hesitation or repetitious movement,

• Completes tasks requiring movement from room to room within hesitation or repetitious movement.

Note tasks or jobs in “comments” section.

Transitions from Task to Task: • Makes at least one transition between tasks without

personal prompt, • Makes at least 3 transitions between tasks without

personal prompt, • Makes all transitions from one task to the next during

work day. • Note type of schedule that assists independent transition.

Stamina in Standing Activities: (specify) • Completes activities while standing for 15 minutes, • for 30 minutes, • for one hour, • for 1 ½ hours

Stamina in Seated Activities: (specify) • Completes seated activities for 15 minutes, • for 30 minutes, • for one hour, • for 1 ½ hours

14

Pass Setting and Structure Emerge Setting and Structure Sustains Quality of Task:

• Sustains quality of task over one hour, • over 2 hours, • over 3 hours, • over one week, • over six week training period. Note tasks or job in “comments” section.

Works at Necessary Speed: (specify) • Work at 50 % of rate expected by employer, • Work at 75% of rate expected by employer, • Work at 100% of rate expected by employer. Note job or tasks in “comments” section.

Response to Corrections: • Accepts correction at planned time (on schedule or work

system) with written or picture cue, • Accepts correction at planned time (on schedule or work

system) with verbal/ personal cue, • Accepts correction at unplanned time in midst of task with

written or picture cue, • Accepts correction at unplanned time in midst of task with

verbal/ personal cue. Note job or tasks in “comments” section.

Self-Calming Strategies: • Responds to visual cue from supervisor to remove self

from stressful situation and engage in pre-established self-calming strategy,

• Responds to verbal cue from supervisor to remove self from stressful situation and engage in pre-established self-calming strategy,

• Independently removes self from stressful situation and engages in self-calming strategy.

In “comments” section, identify the self-calming techniques.

Corrects Mistakes: • Identifies and corrects own mistakes when completing a

task. Note tasks or job in “comments” section.

15

Pass Setting and Structure Emerge Setting and Structure Response to Interruptions:

• Responds to visual cue to stop one job and go to another (does not return to old job independently when finished),

• Responds to verbal cue to stop one job and go to another (does not return to old job when finished),

• Responds to visual cue to stop job and go to another (independently returns to old job and finishes),

• Responds to verbal cue to stop one job and go to another (independently returns to old job and finishes)

16

7. Independent Functioning: In this section please list the individual’s ability to perform daily or work related tasks. List anything that may hinder the ability to complete these tasks independently. This may include slow pace or prompt dependency.


Arrives at Appointments on Time: • Requires personal support to arrive at appointments on

time 90% of time (define type of support), • Arrives at appointments on time independently without

personal prompt 90% of time (identify structure that supports this)

Behavior During Break Time: • Engages independently in hobby or preferred activity

during break that is not disruptive to co-workers for at least 5 minutes

• Engages independently in hobby or preferred activity during break that is not disruptive to co-workers for 15 minutes.

Identify structure and activities in “comments” section.

Behavior During Meal Break: • Independently retrieves and eats meal in designated area, • Cleans up own meal and area after eating, • Independently chooses and engages in non-disruptive

activity after eating.

Manners: • Closes mouth while eating • Wipe mouth throughout meal • Eats only from own plate • Removes own plate and utensils and cleans area after meal • Note other skills:

Response to Schedule Changes: • Responds without confusion or agitation to schedule

changes presented at least one hour prior to change event, • Responds without confusion or agitation to schedule

changes presented 5 minutes prior to change event

17

Pass Setting and Structure Emerge Setting and structure Organizes Work Materials:

• Retrieves and replaces dropped materials in appropriate container or space,

• Independently puts out familiar materials in work space using visual cues to assist speed and quality,

• Independently puts out new materials in work space using visual cues to assist speed and quality.

Follows Safety Procedures: • Looks both ways and crosses street safely • Follows street signs as a pedestrian • Uses kitchen appliances safely • Uses knives and sharp utensils safely • Uses chemicals, household cleaning supplies, etc. safely • Follows posted safety rules in work setting (specify)

Time Management: • Adjusts speed with familiar task in response to supervisor

instruction, • Adjusts speed with familiar task in response to amount of

work in work space, • Adjusts speed of familiar task in response to time deadline

Clothes Care: • Independently chooses appropriate clothing and dresses for

work activity, • Independently chooses appropriate clothing and dresses for

leisure activity, • Independently chooses clean clothes for work and leisure

activities

Maintains Personal Belongings in Correct Place

Identifies Belongings of Others and Refrains from Taking Them Without Permission

18


Menu Planning: • Independently prepares own meal requiring only assembly

(i.e., sandwich and fruit), • Independently prepares own meal requiring simple heating

(microwave, heat soup on stove), • Independently prepares meal requiring at least 5-step

cooking and food preparation, • Independently prepares meal requiring at least 10-step

cooking and food preparation, • Follows a balanced menu plan for week, • Independently prepares and eats at least 2 meals per day.

Personal Hygiene: • Independently bathes regularly, • Independently brushes teeth regularly, • Independently maintains hair daily, • (Male) independently shaves, • (Female) independently cares for menstrual needs, • Independently cares for skin (dryness, cuts, abrasions) • Independently washes/dries hands regularly • Independently goes to the toilet • Independently wipes behind

Medical Needs: • Independently seeks emergency medical attention, • Independently makes medical appointment as needed, • Independently goes to planned medical appointment.

Waits in Line: • Recognizes end of line and takes place, • Stays in line and moves with line • Can wait in line in routine situation

Waiting: (specify setting and structure) • Can wait for up to 1 minute in unexpected delay • Can wait when delay is longer than 1 minute

19


Transportation in Community: • Uses transportation with assistance (note which methods) • Uses transportation alone (note which methods) • Is ready when transportation arrives • Uses proper social behaviors for transportation • Uses private transportation • Identifies and uses correct bus to get to community site

(specify) • Correctly pays for transportation • Changes bus as necessary for commuting to community

site (specify) • Signals to stop on bus route • Arranges private transportation as necessary (phone,

payment, etc.) • Walks to community site safely • Rides bicycle to familiar community site, following safety

rules

Walking inside and outside: • Can go about alone inside a building:

1 to 2 rooms Several rooms Within a building

• Can go about alone outside: Within an area with boundaries Along a known route Between several known places In unfamiliar places

20


Manage Personal Finances: • Independently pays at least 2 bills monthly in a timely

manner, • Independently pays at least 5 bills monthly in a timely

manner, • Independently pays all bills monthly in a timely manner

(Note visual cues or structure used to assist this process in “comments” section),

• Follows a budget (weekly or monthly) and stays within established limits for at least 3 categories of spending (food, transportation, recreational expense),

• Follows a budget for more than 5 categories of spending.

Uses Money to Make Purchases: • Chooses and purchases meals, • Gives correct amount of cash in response to cashier, • Waits for change, • Correctly obtains items from short shopping list (less than

5 items), • Correctly obtains items from long shopping list (more than

5 items)

Checking Account: • Writes checks to make purchase, • Maintains checking account independently (adding and

subtracting in account record), • Makes deposit/withdrawal at bank independently, • Manages account on line • Transfers funds on line

ATM/Debit Card: • Uses ATM card independently for withdrawal, • Deposit, • Balance inquiry,

(Credit card use is not recommended)

21

8. Recreation/Leisure Skills: Describe the individual’s leisure time activities including activities that they can do independently or with others. What do they do in their free time? What are some of their interests; these may or may not be leisure time activities.


Games: Note length of time and other conditions. • Plays board games (identify), • Plays word games (crossword puzzles, find-a-word, Brain

Teasers), • Works puzzles (identify size and type) • Plays card games (identify) • Other

Interaction in Playing Games: Identify games • Plays games alone for 5 minutes • Plays games alone for 15 minutes • Play with one other person, taking turns for 5 minutes • Plays with one other person, taking turns for 15 minutes • Plays with 2 or more people, taking turns for at least 15

minutes

Art: Note length of time and other conditions. • Drawing, Painting, • Photography, • Coloring, cutting and pasting, • Crafts: crochet, knit, rug hooking, etc. • Pottery, sculpting

Hobbies, Collections • Engages in indoor hobby or collection for at least 15

minutes twice monthly • Obtains hobby magazines and reads for pleasure • Budgets to purchase hobby items • Purchases items at hobby store or online

Computer/Electronic Games: • Starts the computer/game independently • Able to stop the game before it is finished by use of visual

cue, timer, etc. (specify) • Able to stop game before it is finished when verbally

directed • Searches internet in appropriate (safe) manner • Plays on-line games

Specify type of games, type of console, hand-held, etc.

22


Reading/Looking at Books or Magazines: • Reads, looks at books or magazines for 5 minutes • Reads, looks at books or magazines for 15 minutes Identify type and level of reading material.

Writing Creatively: • When presented with topic, writes independently for 5

minutes • When presented with topic, writes independently for 15

minutes • Generates ideas on own and writes for 5 minutes • Generates ideas on own and writes for 15 minutes Identify structure or materials needed in “comments” section.

Exercise: • Walks at least 20 minutes (specify environment) twice a

week, • Runs at least 20 minutes twice a week (specify

environment), • Lifts weights at least 20 minutes twice a week (specify), • Uses exercise equipment at least 20 minutes twice a week • Swims • Bicycles • Roller skates • Bowles • Participates in Community Aerobic class • Participates in Community Dances • Other skills

Gathers Items for Leisure Activity Independently and Puts Away When Finished: (specify activities in “comments”)

Independent in Leisure Activity: • Occupies self for 5-10 minutes with preferred/appropriate

activity (identify: sensory, simple cause-effect, etc.) • Occupies self for 15-2- minutes with preferred activity

23

Pass Setting and Structure Emerge Setting and Structure Independent in Outdoor Leisure Activities:

• Occupies self for 5-10 minutes with preferred outdoor activity (identify: hammock, swing, trampoline, etc.)

• Occupies self for 15-20 minutes with preferred activities

Participates in Community Leisure Activities: • Attends movies • Attends sports events • Attends concerts, plays, or entertainment events • Attends fairs, exhibits, museums, etc. (specify)

Plans Community Events: • Budgets for community event • Obtains information from newspaper, web site, etc. on

time, place, and cost • Arranges transportation for outing

Chooses from a Variety of Activities: • Independently chooses only one leisure activity on a

consistent basis • Independently chooses 2-4 leisure activities • Independently chooses more than 4 different leisure

activities

Pet Care: • Feeds fish, turtle, hamster, etc. on daily basis • Cleans small animal cage or aquarium and changes

bedding or water • Feeds and waters larger animal (dog, cat) on daily basis • Recognizes veterinary needs and arranges vet visit

24

9. Communication: Describe individual’s communication skills including his/her ability to follow verbal or written directions, the speed with which he/she processes information. Also describe expressive communication skills including his/her ability to express personal or work related needs and the method he/she uses to communicate. Does the individual talk a lot about limited topics or ask a lot of questions


Primary Method of Expressive Communication: • Uses objects to communicate personal needs (describe

format and content) • Uses pictures to communicate personal needs (describe

format and content) • Uses picture/word cards to communicate (describe format

and content) • Uses written communication system (describe format and

content) • Uses verbal language to communicate (describe content)

Follows Directions: • When presented with familiar object, uses object to make

transition or to complete direction (specify) • When presented with picture, uses picture to make

transition or to complete direction (specify) • When presented with picture/word card, uses card to make

transition or to complete direction (specify) • When presented with written card or cue, uses cue to

make transition or to complete direction (specify) • When presented with verbal directions, follows direction

or makes transition (specify) • Specify number of steps individual can independently

complete and give examples:

Obtains Individual’s Attention Appropriately: • Gestures to obtain attention (specify) • Makes general statement to get attention (specify – Hey,

Excuse Me, etc.) • Calls individual’s name to obtain attention • Makes eye contact while using one of these methods

Requests Help: • When individual runs out of work or need materials. • When individual needs information • When needing a tool or material repaired

25


Communicates Personal Needs or Pain: • Communicates pain or illness (specify how) to someone

who can help • Communicates hunger or thirst to someone who can assist

(specify how) • Communicates cold or heat or personal discomfort to

someone who can assist (specify how) • Other personal needs/preferred activity •

Provides Emergency Information: • Presents pre-made card upon request. • Gives names upon request (specify how-verbally or in

writing, etc.) • Gives address upon request and to appropriate person • Gives phone number upon request and to appropriate

person • Gives name of emergency contact upon request

Volume of Speech: • Uses moderate voice volume in interaction/conversation. • Modulates tone and voice depending on the noise level in

the environment.

Contacts Site when he/she will be absent

Appropriately rejects (gestures, shakes head, verbally, other method)

Tells someone to ‘stop’ or ‘leave me alone’ Requests that an activity be terminated Points to/identifies work that is completed Points to/identifies work to do/not yet completed Correctly identifies quality of work (simple task, specify) Correctly identifies quality concept (smooth, clean, painted, etc.)

Identifies when finished or not finished States or indicates preferences (likes or dislikes) Notes fatigue in self Identifies fear, anger, in self Identifies ‘fun’ activities

26

10. Interpersonal Skills: Describe individual’s social behaviors including his/her affect, ability to take another’s perspective, response to other’s emotions, and typical ways of interacting with others. Describe typical social interactions in terms of whether individual displays appropriate social behaviors (uses greetings) good working skills, appropriate social distance, etc.) and avoids inappropriate social behaviors (e.g. swearing, picking nose, etc.)


Appropriate Language: • Refrains from swearing • Refrains from talking about inappropriate topics (If not, specify)

Initiates social Interaction: • Initiates social interactions without prompt • Initiates interaction at appropriate times (during breaks, at

lunch, etc.) and not excessively

Participates in Social Events: • Participates in small group activity (family dinner, small party

of less than 8) • Participates in large group social activities (church service,

wedding, large party of more than 8) • Shares information about social activities with others

Maintains Appropriate Personal Space: • Refrains from physical contact with strangers or acquaintances • Refrains from excessive physical contact with familiar people or

friends • Maintains appropriate distance during conversation or

interaction

Greeting Others: • Initiates appropriate greeting with familiar people • Initiates appropriate greeting with strangers

Conversation and Response to Initiation by Others: • answers yes/no questions • answers simple information questions • responds appropriately when he/she does not know the answer • answers questions and follows by asking similar question • makes a related comment on topic of conversation • asks about other’s interests • recognizes when a conversation is ended and ends it

appropriately • engages in more than just a few topics (if not, specify topics) • responds to change of subject by other individual • enter discussion during break in conversation

27

Pass Setting and Structure Emerge Setting and Structure Response to Questions in Work Setting:

• Responds to a stranger’s (customer’s) question either by answering or referring to another person

• Provides sufficient and accurate answer without excessive interaction

Follows Posted Social Rules in Work Setting: • Uses posted social rules to curb or redirect own behavior

(specify)

Uses Appropriate Outlets for Emotional Needs: • Requires only occasional support or praise (specify amount and

type) • Refrains from discussing personal/emotional problems during

work times • Refrains from excessive review of personal emotional problems

with familiar people • Refrains from discussion of personal/emotional problems with

strangers or acquaintances

Refrains from inappropriate touch of self or others in public

Refrains from making inappropriate noises in public

Refrains from inappropriate phone, chat, IM, tweeting, or text messaging,

Copes with frustration: • Identifies appropriate time and person with whom to

discuss personal/emotional problems

Tolerates presence of others in work activities: • Works with another person in the same room • Works beside another person in a work station • Shares materials with another person while working • Gives or takes materials from another person while

working • Waits for another to finish portion of task in order to

complete own task

28

11. Mobility: Transportation is often one of the most overlooked components of the assessment. Please note the ability to access the transportation system in the area and if the individual has difficulty transitioning from one task to another within a work setting.


Method of Transportation (walk, bike, bus, car) • Use the bus system • Transfer bus • Read the schedule and find correct bus and time • Follow traffic safety rules • Ride a bike safely • Drive a car safely

Arrange Own Transportation: • Call a cab • Maintain a car (specify skills) • Maintain a bike (specify skills) • Obtain bus tickets

Need Special Travel Arrangements: • Needs means of travel to be handicapped accessible • Needs specialized communication system for

communication • Needs photo or picture book to remind individual when to

signal for stop

Follow a Map or Directions: • Uses a map to find a place or building • Asks for directions

29

12. Environmental Factors: Describe responses to typical Environmental Factors in the area – Do they appear to be bothered by people or things nearby?


Noise Level: (Note if not disturbed or overly distracted) • Response to loud noises • Response to soft noises • Response to people talking nearby • Response to unexpected/unpredictable noises

Visual Stimuli or Lighting: • Response to brightness • Response to dark • Florescence flicker • Colors or patterns of walls and area • Unusual activities that interest individual

Response to Temperature Extreme: • Too cold • Too hot • Too humid

Response to dirty environment Response to Wet Environment Proximity of materials: (Note if not disturbed or overly distracted)

• When materials are close by. • When materials are far away, out of reach Note any materials that distract from performance.

Response to Proximity of Other People: • Can work with others within 5 feet • Can work with others who are within 10 feet • Stay at least arms length away from others they are

working with. • Stays out of others workspace.

Response to Movement Around Them • Respond appropriately to moving machinery • Respond appropriately to moving people • Respond appropriately to sudden movement

Responds appropriately to smells, fumes, odors: