Little Steps Therapy Services

DATA SHEET – TOILETING PROGRAM

GOAL: To improve independence with toileting skills
NAME:
● Take note if ____ is wet or dry at every bathroom visit.
● Ask ____ if he feels wet or dry at the bathroom
● If he has an accident, keep a neutral tone of voice, help him change and avoid giving the accident lot’s of importance
DATE: 2017
Toilet
Express when needing to use
toilet
Pull pants down
Pull-up or underwear down
Sit on or stand at toilet
Void in toilet: urination
Void in toilet: bowel movement
Wipe self
Pull-up or underwear up
Pull pants up
Flush toilet
Hand washing
Initiated washing hands
Wash hands
Dry hands

Time of day
Wet/Dry
OT – Toileting Data Sheet
 Little Steps Therapy Services

BI Initials

✓ = completed G=Gestural prompt V = verbal prompt P= Physical prompt X = unable to complete

OT – Toileting Data Sheet