Discriminates between hot / Pours liquid from pitcher Understands food” “healthy cold food vs food” “junk Equipment Needed: See OT Assessment, DSHS 10-XXX, for all adaptive equipment. Meal Preparation: Y N Resident assists with meal preparation; if yes, specify: Resident Preferences: Y N Expresses preferences: Participates in making choices: COMMENTS (EXAMPLES: 1) Resident is only provided spoon. Could use training in the use of a fork; 2) Has tendency to throw items; AND 3) Resident could benefit from learning to pour his / her own liquids): Household Management Skills: On each line below, enter the number that best represents the resident’s present level of ability for each skill: 1. Physical 3. Verbal 5. Self-Reliant 2. Gestural 4. Independent N/A Not Applicable Knows when cleaning / Brings dirty laundry to Puts napkins on organizing of personal laundry room Puts glasses on table space should be done Sorts clothing Puts silverware on table Keeps own area tidy Loads / unloads washer Puts plates / bowls on table Makes bed and dryer Selects clothing protector / Stores and maintains own Folds clothing napkin property clothing Places clothing protector / Dust / surfaces Puts away own clothing napkin in hamper Empties trash table Busses dishes from table Turns on / off lights Prepares a sandwich or Locks / unlocks lock with Turns power on / off (TV, food item key radio, etc.) Puts centerpiece on Puts dirty laundry / clothes Puts placemats on in hamper Y N Understands responsibility of key possession (i.e., does not give key to others, keeps key safe, uses it for intended use. Tells time: by event by timepiece Resident Preferences: Expresses preferences: COMMENTS / OPPORTUNITIES FOR INCREASING INDEPENDENCE AND RIGHTS (EXAMPLES: 1) Activates electronics with use of a switch; AND 2) Resident can fold clothes but could work on putting them away in his / her drawers): Money Management Skills: On each line below, enter the number that best represents the resident’s present level of ability for each skill: 1. Physical 3. Verbal 5. Self-Reliant 2. Gestural 4. Independent N/A Not Applicable
Discriminates between hot / cold food Pours liquid from pitcher Understands “healthy food” vs “junk food” Equipment Needed: See OT Assessment, DSHS 10-XXX, for all adaptive equipment. Meal Preparation: Y N Resident assists with meal preparation; if yes, specify: Resident Preferences: Y N Expresses preferences: Participates in making choices: COMMENTS (EXAMPLES: 1) Resident is only provided spoon. Could use training in the use of a fork; 2) Has tendency to throw items; AND 3) Resident could benefit from learning to pour his / her own liquids): Household Management Skills: On each line below, enter the number that best represents the resident’s present level of ability for each skill: 1. Physical 3. Verbal 5. Self-Reliant 2. Gestural 4. Independent N/A Not Applicable Knows when cleaning / organizing of personal space should be done Keeps own area tidy Makes bed Stores and maintains own property Dust / surfaces Empties trash Turns on / off lights Turns power on / off (TV, radio, etc.) Puts dirty laundry / clothes in hamper Brings dirty laundry to laundry room Sorts clothing Loads / unloads washer and dryer Folds clothing clothing Puts away own clothing table Prepares a sandwich or food item Puts centerpiece on Puts placemats on Puts napkins on Puts glasses on table Puts silverware on table Puts plates / bowls on table Selects clothing protector / napkin Places clothing protector / napkin in hamper Busses dishes from table Locks / unlocks lock with key Y N Understands responsibility of key possession (i.e., does not give key to others, keeps key safe, uses it for intended use. Tells time: by event by timepiece Resident Preferences: Expresses preferences: COMMENTS / OPPORTUNITIES FOR INCREASING INDEPENDENCE AND RIGHTS (EXAMPLES: 1) Activates electronics with use of a switch; AND 2) Resident can fold clothes but could work on putting them away in his / her drawers): Money Management Skills: On each line below, enter the number that best represents the resident’s present level of ability for each skill: 1. Physical 3. Verbal 5. Self-Reliant 2. Gestural 4. Independent N/A Not Applicable
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