COMMUNITY SKILLS ASSESSMENT

Training Key
* = High Priority

Student: Student L

= Suggested

Frequency

Assessment Date:

Participation Levels
Completed by:

I = Independent

0 = once a month or le
3 = 2 to 3 times a mon

P = Partial Participatio

5 = once a week or m
Environment

Location (s)

Name of Community
Activity

Partial Participation and

Comments

Adaptation

Particip.
Level

Current

Restaurants
Macdonalds

Throws away trash

in the bin
Eats any type of
food ordered for
him
Skill

Skill
Hawker Centre

Student L will hand lead or point to

Choosing food that food that he wants to eat after
he wants to eat
walking around in the hawker centre
with adult.

0 X
3
5 *

Frequency Key
0 = once a month or less
3 = 2 to 3 times a month

Yes
No

5 = once a week or more

Weighting
Environment
Future

Year 1
School

Weight
Needed

Rank

Training

Year 2

Date

Rank

Year 3

Date

Rank

Date

2016

Yes

2016

Yes

2016

Begun

Completed

Environment
Location (s)

Name of Community
Activity
Skill
Skill

Location

Skill
Skill
Skill
Skill

Location

Skill
Skill
Skill
Skill

Location

Skill
Skill
Skill

Partial Participation and

Comments

Adaptation

Particip.
Level

Current

gg

Weighting
Environment
Future

Year 1
School

Weight
Needed

Rank

Training

Year 2

Date

Rank

Year 3

Date

Rank

Date

2016

2016

2016

Begun

Completed

Environment
Location (s)

Name of Community
Activity

Partial Participation and

Comments

Adaptation

Particip.
Level

Current

Skill
Location

Skill
Skill
Skill
Skill

Stores/Shops

Skill
Skill

Departmental Store

Skill
Follows parent
throughout the
duration of buying
things in the store
Skill
Skill

Weighting
Environment
Future

Year 1
School

Weight
Needed

Yes

Rank

Training

Year 2

Date

Rank

Year 3

Date

Rank

Date

2016

2016

2016

Begun

Completed

Environment
Location (s)

Name of Community
Activity
Skill

Location

Skill
Skill
Skill
Skill

Location

Skill
Skill
Skill
Skill

Location

Skill
Skill
Skill
Skill

Partial Participation and

Comments

Adaptation

Particip.
Level

Current

Weighting
Environment
Future

Year 1
School

Weight
Needed

Rank

Training

Year 2

Date

Rank

Year 3

Date

Rank

Date

2016

2016

2016

Begun

Completed

Environment
Location (s)
Location

Name of Community
Activity

Partial Participation and

Comments

Adaptation

Particip.
Level

Current

Skill
Skill
Skill
Skill

Social Services
Hairdresser

Sit on the chair in

Lewis will be given toys and iPad to
the salon until
get distracted when hairdresser is
hairdresser finishes
cutting or shaving his hair
cutting his hair
Skill
Skill
Skill

Location

Skill
Skill
Skill
Skill

Weighting
Environment
Future

Year 1
School

Weight
Needed

Yes

Rank

Training

Year 2

Date

Rank

Year 3

Date

Rank

Date

2016

2016

2016

Begun

Completed

Environment
Location (s)
Location

Name of Community
Activity
Skill
Skill
Skill
Skill

Location

Skill
Skill
Skill
Skill

Location

Skill
Skill
Skill
Skill

Location

Skill

Partial Participation and

Comments

Adaptation

Particip.
Level

Current

Weighting
Environment
Future

Year 1
School

Weight
Needed

Rank

Training

Year 2

Date

Rank

Year 3

Date

Rank

Date

2016

2016

2016

2016

Begun

Completed

Environment
Location (s)

Name of Community
Activity

Partial Participation and

Comments

Adaptation

Particip.
Level

Current

Skill
Skill
Skill
Health
Doctor's clinic

Stays in the doctor's

Student L will be given toys or iPad
clinic until the
to be distracted while doctor is
doctor has finished
conducting his checkup.
his checkup
Responds to name
Skill
Skill

Location

Skill
Skill
Skill
Skill

Location

Skill

Weighting
Environment
Future

Year 1
School

Training

Year 2

Year 3

Weight
Needed

Rank

Date

Yes

2016

2016

2016

Rank

Date

Rank

Date

Begun

Completed

Environment
Location (s)

Name of Community
Activity
Skill
Skill
Skill

Location

Skill
Skill
Skill
Skill

Location

Skill
Skill
Skill
Skill

Location

Skill
Skill

Partial Participation and

Comments

Adaptation

Particip.
Level

Current

Weighting
Environment
Future

Year 1
School

Weight
Needed

Rank

Training

Year 2

Date

Rank

Year 3

Date

Rank

Date

2016

2016

2016

Begun

Completed

Environment
Location (s)

Name of Community
Activity
Skill
Skill

Partial Participation and

Comments

Adaptation

Particip.
Level

Current

Weighting
Environment
Future

Year 1
School

Weight
Needed

Rank

Training

Year 2

Date

Rank

Date

Year 3

Rank

Date

Begun

Completed

Rank Ordered List

Throws away trash in Eats any type of food
the bin
ordered for him

Skill

Skill

Hawker Centre

Choosing food that he

wants to eat

Skill

Skill

Departmental
Store

Follows parent
throughout the
duration of buying
things in the store

Skill

Skill

Skill

Hairdresser

Sit on the chair in the

salon until hairdresser
finishes cutting his
hair

Skill

Skill

Skill

Doctor's clinic

Stays in the doctor's

clinic until the doctor
has finished his
checkup

Responds to name

Skill

Skill

Macdonalds

Rank Ordered List

Rank Ordered List