Bathroom Skills/Toilet Use Requests bathroom if during task Comments (Date and Separate) Walks to bathroom by self (10 behind) Opens door and enters bathroom Closes door/stall door Stands in front of toilet Removes fanny pack, if worn Asks adult to leave if not needed Turns facing away from toilet Lowers necessary clothing Sits on toilet w/ genitals over/in opening Discharges in toilet only (no spill) Wipes self until paper is clean Stands up from toilet Raises clothing Fastens all buttons, zippers, and belt Puts on fanny pack Flushes toilet Walks to sink Turns on water Wets, soaps, and washes hands adequately Dries hands Throws away an paper towel Adjusts clothing, if needed Leaves bathroom Returns to previous activity Requests assistance, if needed
Bus Use Identifies correct time for bus Comments (Date and Separate) Obtains all needed materials Walks to bus stop Arrives before bus (on time) Waits for bus to arrive Gets money in hand when bus is visible Boards bus Asks driver route number/confirms Hands payment to driver Asks driver to call out desired stop Requests transfer Takes transfer from driver Places transfer in secure holder Sits in appropriate seat (to hear driver) Talks only to those in party Pulls cord at appropriate stop OR Stands when driver calls desired stop Stands when bus comes to stop Exits bus to sidewalk INDEPDNDENCE RATIO
Cooking and Kitchen Use Gathers all necessary food items Comments (Date and Separate) Washes hands Finds kitchen tools as needed Follows all recipe steps, in sequence Y or N: Completed in reasonable time? Sets table: plate, utensil, napkin Sets cup on table Pours drink Scrapes any food off plate into garbage Puts dishes in sink Throws away garbage Washes dishes Dries dishes Puts dishes away Wipes table Picks up food off floor Washes/wipes floor, if needed Frustration Level 1(low) 5(high) Kitchen tools or objects (circle if used) Blender Can opener Set oven/stove Toaster Hot Pads/Mitts Knife for cutting Cutting board Colander Measure cups Measure spoons
Eat-In Restaurant Identifies desired food Comments (Date and Separate) Identifies appropriate restaurant Identifies transportation source Tells staff time to go/leave Walks to transportation appropriately Walks from van/cab to restaurant Enters restaurant Waits by wait sign to be seated Greets wait staff appropriately Walks with group to seat Sits in appropriate seat Opens and looks at menu States food choice States drink choice Identifies if has enough $ for cost Gives order when asked by waiter Waits for food appropriately Eats food appropriately Looks at bill for cost Takes out enough $ for bill Pay for item at cashier or waiter Used $ Over (Yes or No: Y N) Gives $2 tip Says thank you to waiter Waits in area for rest of group Exits restaurant with group Asks for help as needed S
Fast Food Restaurant Identifies appropriate restaurant Identifies desired items to order Identifies enough money for order Identifies transportation Tells staff when to go Walks to transportation Walks from van/cab to restaurant Enters restaurant Walks to end of line Stands in line appropriately States desired item to cashier, when asked Pays for item when told price Uses $ Over (Yes or No: Y N) Waits for food Steps to side if asked/indicated Says thank you when given food Takes food tray Walks to appropriate table Uses napkin when needed Talks with empty mouth Chews with closed mouth Puts all trash on tray Takes tray to trash Places tray on holder Waits for group Exits restaurant with group Asks for assistance, if needed S
Shopping General Identifies store to shop at Makes list of items needed Estimates total $ needed Places $ in wallet or purse Walks from van/cab to store Takes basket or cart if needed Finds items according to list Identifies fresh food/buy? Identifies expiration date/buy? Identifies brand/buy? Identifies price/buy? Gathers each item in possession Walks to check out counter/cashier Enters line, if needed Stands appropriately in line Places items on table, right time Greets clerk Pays for items when told price Uses $ Over (Yes or No: Y N) Waits for and takes change Says Thank you to clerk Takes items in bag Exits store with group Asks for help if needed
Grocery Store Identifies items to purchase Places items on list Gets enough $ for purchase Places $ in wallet or purse Identifies when time to go Walks with list to store/van Enters store Has grocery list out Gets cart/basket if needed Pushes cart Finds items on list Does not grab items not on list Puts each item in cart Walks to open check out lane Stands in line, if needed Unloads cart when turn Answers plastic, if asked Gets $ out while waiting Pays for item when told price Uses $ Over (Yes or No: Y N) Takes change and receipt Puts money away Puts wallet in pocket/purse Secures bag Exits check out Waits for group Exits store with group Asks for help if needed
Health Club Walks to transportation on time Walks from van/cab to HC Enters HC Greets attendant when checking in Enters locker room Finds correct locker Unlocks and opens locker Hangs up coat & fanny pack Takes work out clothes from bag Removes street clothes Puts on work out clothes Puts clothes and bag in locker Closes and locks locker Walks to exercise area Starts exercise options Treadmill Bike Rowing machine Walk laps Weight lifting Completes exercise options Walks to locker room when time Unlocks and opens locker Takes off work out clothes Dresses in street clothes Places work out clothes in bag Closes locker and locks Leaves health club Asks for assistance as needed
Laundry Identifies when time to go Gathers laundry in basket Gathers laundry supplies Takes laundry to transportation Takes laundry/supplies out of van Walks to and enters Laundromat Selects unused washing machine Separates clothes by colors Inserts correct detergent amount Inserts correct coin amount Adjusts washer settings as needed Starts washer Waits appropriately Walks to washer when cycle ends Removes clothes Puts wet clothes in empty dryer Closes dryer Inserts correct coin amount in dryer Sets dryer settings, if needed Starts dryer Waits appropriately Walks to dryer when cycle ends Removes clothes Folds clothes as needed Places folded clothes in basket Repeats steps if has more laundry Asks for help as needed INDEPDENDENCE RATIO
Street Crossing 2-LANE, NO SIGN Walks to corner Stops at curb Looks left and right for cars Leaves curb after cars pass Looks left and right while crossing Walks in crosswalk 2-LANE, STOP SIGN Walks to corner Stops at curb Looks left and right for cars Leaves curb when all cars have stopped Looks left and right as crossing street Raises hand if car moves while crossing Walks in crosswalk 2 OR 4 LANE WITH STOPLIGHT Presses signal button Walks to corner/crosswalk Stops on curb Looks at signal until changes Starts crossing after signal change Raises hand if car moves while crossing Keeps walking until reaches curb
University Course Attendance Tells staff when its time to leave Walks to van at right time Walks from van/cab to class Sits in appropriate seat Says hello to peers Attends to lesson Quiet while teacher talks Looks at teacher during lecture Writes notes, if needed Maintains appropriate behavior Participates/Answers questions Says goodbye to peers Leaves class when time Walks from class to van/cab
Vocational Changes into uniform, if needed Checks self in mirror w/ checklist Looks for cab until it arrives Walks to cab Arrives in appropriate dress Properly groomed for work Walks from cab to workplace Enters workplace Greets coworkers Gathers needed materials Starts work routine # of tasks in routine # of tasks completed # Additional tasks completed Changes tasks appropriately Stops work at break time Walks to break area Is appropriate during break Leaves break on time Returns to work area/task Requests break as needed Identifies time when to stop work Returns work materials when done Walks and waits for transportation Longest period worked without cues or help
Transportation VAN/CAB Opens door Gets in seat correctly Closes door, if needed Pulls seat belt across chest and waist Clicks belt in place Waits until fully stopped before starts to remove seat belt Removes seat belt Opens door and exits van WALKING Walks on sidewalk with group Remains with group (10 close) Stops when group stops S
ATM Withdrawal Moves from street corner to bank Enters bank door Enters line if needed remains 5 behind person using ATM walks to ATM when turn Gets card out inserts card in slot rotates and reinserts card correctly if inserted incorrectly 1 st time. waits until screen prompts correctly types in PIN # selects correct account inputs correct withdrawal amount presses enter to confirm presses cancel if typed incorrectly takes money answers no to additional exchanges waits for card and takes when ejected places card in wallet takes receipt from machine places receipt in wallet places wallet in pocket or purse gets 20 $1 bills
Check Deposit gathers necessary deposit papers removes card with account info. writes deposit amount on slip writes account info on slip signs back of check enters bank door enters line for cashier walks up to cashier asks to deposit check waits for deposit receipt takes receipt says thank you exits line leaves bank with group Additional
WALKING CLUB Chooses where to walk Comments (Date) Changes shoes if necessary Changes shirt is necessary Walks to transportation Wears seatbelt correctly Gets out of van Walks to site Starts walking Walks for designated amt. of time Stays in area Stops at designated time Gets in van Wears seatbelt correctly Gets out of van Changes shoes if necessary Changes shirt if necessary Completes Prep Completes Review