Learner: ____________________ Assessment of Functional Living Skills

Assessor Date Color Code Skills Tracking System

Basic Living Skills

TL41
TL40 HS39
TL39 HS38
HS37
DR37 TL38
DR36 TL37 HS36
TL36 HS35
DR35 TL35 HS34
DR34 TL34 HS33
DR33 GR34 HS32
TL33 GR33 HS31
DR32 TL32 GR32 HS30
DR31 TL31 GR31 HS29
DR30 TL30 GR30 HS28
DR29 TL29 GR29 HS27
DR28 TL28 HS26
DR27 TL27 GR28
DR26 TL26 GR27 HS25
SM25 TL25 GR26 HS24
SM24 DR25 TL24 GR25 HS23
SM23 DR24 TL23
SM22 BC22 DR23 TL22 GR24 HS22
SM21 BC21 DR22 TL21 GR23 HS21
BC20 GR22 HS20
SM20 BC19 DR21 TL20 GR21 HS19
SM19 DR20 TL19 GR20 HS18
SM18 BC18 DR19 TL18 GR19
SM17 BC17 DR18 TL17 GR18 HS17
SM16 BC16 DR17 TL16 GR17 HS16
SM15 BC15 DR16 TL15 GR16 HS15
SM14 DR15 TL14 GR15 HS14
SM13 BC14 TL13 GR14 HS13
SM12 BC13 DR14 GR13 HS12 NR14
SM11 BC12 DR13 TL12 BT13 NR13
SM10 BC11 DR12 TL11 GR12 BT12 HS11 NR12
SM9 BC10 DR11 TL10 GR11 BT11 HS10 NR11
SM8 BC9 DR10 TL9 GR10 BT10 HS9 NR10
SM7 DR9 TL8 GR9 BT9 HS8 NR9
BC8 DR8 TL7 GR8 BT8 HS7 NR8
SM6 BC7 DR7 GR7 BT7 HS6 NR7
SM5 BC6 DR6 TL6 GR6 BT6 NR6
SM4 BC5 DR5 TL5 GR5 BT5 HS5 NR5
BC4 DR4 TL4 GR4 BT4 HS4 NR4
SM3 BC3 DR3 TL3 GR3 BT3 HS3 NR3
SM2 BC2 DR2 TL2 GR2 BT2 HS2 NR2
SM1 BC1 DR1 TL1 GR1 BT1 HS1 NR1

SM Self BC Basic DR Dressing TL Toileting GR Grooming BT Bathing HS Health, Safety NR Nighttime

Management Communication and First Aid Routines

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