5 6 7 8 9 10 For each of the domains below, check the box that best describes the type of instruction or support you should be providing for the majority of the activities (check more than one if needed): None – I will need I will need I will need I will I will I will the to to provide to give the need to need to need to person “monitor” motivation person do this do most do most doesn’t and only reminders along things, things in need help when with the but this area supports needed or person involve for the in this asked and teach person area the person as much as possible Home Living Community Living
5 6 7 8 9 10 For each of the domains below, check the box that best describes the type of instruction or support you should be providing for the majority of the activities (check more than one if needed): None – the person doesn’t need supports in this area I will need to “monitor” and only help when needed or asked I will need to provide motivation I will need to give the person reminders I will need to do this along with the person I will need to do most things, but involve and teach the person as much as possible I will need to do most things in this area for the person Home Living Community Living