Student Skills Checklist by Domain Area
Name: Date: DOB: Grade:
Dad’s Name: Work Phone: Home Phone:
Mom’s Name: Work Phone: Home Phone:
Community Domain
Mobility: The student can…Walk with physical assistance / Walk independently
Use wheelchair independently / Follow group
Ride a bicycle safely / Move within a building
Cross residential streets safely / Ride RTD independently
Cross business streets safely / Use RTD with transfers
Visit friends and community sites / Read RTD schedule
Read and understand community signs / Drive a car
Comments:
Financial: The student can…
Complete money exchanges / Count change
Use dollar-over strategy to purchase / Understand the value of money
Use bank services / Use ATM/credit card
Write a check / Balance checking/savings account
Budget purchases / Pay bills
Write/read shopping list / Use modified shopping list
Locate items in a store / Calculate tax/tip
Comments:
Accessing Resources: The student can…
Enter/exit community resources / Utilize community facilities
Make appointments for self / Identify community resources
Identify strategies when in danger / Use strategies when lost
Use strategies for emergencies / Manage time
Adapt to a new routine / Supply necessary ID
Ask for help / Greet people
Express wants/needs/feelings / Use the phone
Give personal information / Order food independently
Use pictures to order food / Answer questions
Use augmentative device / Engage in conversation
Comments:
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Vocational Domain
Job Preparation: The student can…Conduct a job search / Set realistic job/career goals
Participate in work experience / Fill out a job application
Identify financial needs for work / Interview for a job
Identify vocational strengths/interests / Participate in volunteer jobs
Dress appropriately for an interview / Introduce self
Comments:
On the Job: The student can…
Work independently / Stay on task until completion
Organize work area / Problem solve tasks
Follow 1-2 step directions / Maintain work stamina
Use accommodations on the job / Work at satisfactory rate
Follow work schedule / Take breaks/lunch
Accept criticism/feedback / Work well with supervisors
Use adaptive equipment for job / Be on time/punctual
Demonstrate good attendance / Dress appropriately for work
Work cooperatively with co-workers / Follow work routine
Handle job stress / Wear clean uniform/clothes
Demonstrate computer skills / Read/write information
Comments:
Recreation and Leisure Domain
Recreation and Leisure: The student can…Establish exercise program/routine / Participate in recreational activity
Be a member of a social club/group / Enjoy sports with others
Collect or enjoy crafts/hobbies / Access community sites
Plan vacations / Use supports in recreation
Demonstrate likes/dislikes / Play alone
Maintain friendships / Attend social functions
Comments:
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Residential Domain
Personal Hygiene: The student can…Dress/undress / Bathe/shower independently
Brush teeth / Use deodorant
Brush/style hair / Dress appropriately for weather
Cares for menstrual cycle / Toilet self
Participate in changing / Choose/wear clean clothes
Comments:
Domestic: The student can…
Keep room clean/organized / Clean areas of home
Operate a vacuum cleaner / Use a dishwasher
Use a washing machine / Use a dryer
Hand wash dishes / Use stove top
Use oven safely / Use microwave
Use a kitchen timer / Set table
Uses adaptive equipment in kitchen / Contribute to work at home
Comments:
Healthy Lifestyle: The student can…
Plan nutritionally balanced menu / Prepare shopping list for menu
Prepare meal/snack for self / Follow written recipe
Follow picture/modified recipe / Maintain safely at home on own
Take medication independently / Monitor health issues
Use manners / Feed self
Host gatherings at home with others / Practice safe sex
Be alone at home / Contact emergency services
Develop relationships with others
Comments:
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