PERSONAL SUPPORT INVENTORY To be filled out by: Parent/Family/Guardian/Support person Instructions: Please use the following scale to represent level of functioning in each section. Be honest and accurate based on the skill level at this time. (3) Student is independent (2) Student requires some/moderate support (1) Student requires complete support Where necessary, write notes to explain scaled responses AND FOOD PREPARATION EATING Preparing meals and snacks: Current Level of Functioning ingredients and equipment Gathers 3 2 1 containers Opens recipe Follows microwave Uses top Uses oven Uses Eating meal Current of Functioning motor skills i.e., chewing/swallowing Oral 3 2 1 utensils Uses manners Uses Preparing eating area Current Level of Functioning table Sets 3 2 1 condiments Gets Cleaning up after meal Current of Functioning away leftovers Puts 3 2 1 off work surface Wipes dishes Washes Hand washing Using Dishwasher Accessibility to kitchen Current Level of Functioning adaptive equipment Uses 3 2 1 Skills We Should All Focus on Most: AND DRESSING GROOMING Grooming: Current Level of Functioning teeth 3 2 1 Brushes mouthwash Uses hair Brushes/combs hair Styles care Skin make-up Uses eyeglasses Cleans
PERSONAL SUPPORT INVENTORY To be filled out by: Parent/Family/Guardian/Support person Instructions: Please use the following scale to represent level of functioning in each section. Be honest and accurate based on the skill level at this time. (3) Student is independent (2) Student requires some/moderate support (1) Student requires complete support Where necessary, write notes to explain scaled responses EATING AND FOOD PREPARATION Preparing meals and snacks: Gathers ingredients and equipment Opens containers Follows recipe Uses microwave Uses top Uses oven Current Level of Functioning 3 2 1 Eating meal Oral motor skills i.e., chewing/swallowing Uses utensils Uses manners Current of Functioning 3 2 1 Preparing eating area Sets table Gets condiments Current Level of Functioning 3 2 1 Cleaning up after meal Puts away leftovers Wipes off work surface Washes dishes Hand washing Using Dishwasher Current of Functioning 3 2 1 Accessibility to kitchen Uses adaptive equipment Current Level of Functioning 3 2 1 Skills We Should All Focus on Most: GROOMING AND DRESSING Grooming: Brushes teeth Uses mouthwash Brushes/combs hair Styles hair Skin care Uses make-up Cleans eyeglasses Current Level of Functioning 3 2 1
UP_application_2018.docx