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Participant detailed information
Toileting and Mobility
Toileting
(Required)
Completely independent
Needs assistance sometimes
Needs assistance monthly (e.g. menstruation)
Completely dependent
Please explain
(Required)
Mobility
(Required)
Independent
Walks with assistance
Needs assistance with stairs
Uses wheelchair independently
Uses wheelchair with assistance
Please explain
(Required)
Communication
Receptive Speech
(Required)
Understands complex instructions
Understands if shown by example
Understands simple instructions
Understands sign language
Does not understand
Please explain
(Required)
Expressive Speech
(Required)
Uses sentences
Uses words or short phrases
Uses sign language
Uses sounds and gestures
Uses commuication device (e.g. PECS)
No communication
Please explain
(Required)
Behaviour
Physical Aggression
(Required)
Never
Rarely
Sometimes
Often
What are their triggers?
(Required)
How do we avoid or prevent these situations? What are the best practices in assisting in the situation?
(Required)
Frustration
(Required)
Never
Rarely
Sometimes
Often
What are their triggers?
(Required)
How do we avoid or prevent these situations? What are the best practices in assisting in the situation?
(Required)
Outbursts
(Required)
Never
Rarely
Sometimes
Often
What are their triggers?
(Required)
How do we avoid or prevent these situations? What are the best practices in assisting in the situation?
(Required)
Extreme Shyness
(Required)
Never
Rarely
Sometimes
Often
What are their triggers?
(Required)
How do we avoid or prevent these situations? What are the best practices in assisting in the situation?
(Required)
Supervision required
Capable of carrying out tasks without supervision
(Required)
Rarely
Sometimes
Often
Works well in small groups
(Required)
Rarely
Sometimes
Often
Do they need assistance or require more supervision?
(Required)
Yes
No
Please explain in detail
(Required)
Interacting with the general public
Does the participant require one-on-one support?
(Required)
Yes
No
Does the participant have a personal support worker that would be assisting during the day?
(Required)
Yes
No
Please feel free to tell us anything else that will help us meet the needs of the participant.