WORKSITE SKILL RESPONSIBILITY CHECKLIST
Student: ______Date: ______
Training Site: ______Schedule: ______
Supervisor: ______Job Coach: ______
Please rate using letter that correctly describes students’ performance.
MA = Maximum Assistance SI = Semi-Independent I = Independent Skill/Task Analysis
PP = Physical Prompt Required VP = Verbal Prompt Required NP = Requires No Prompt S = Strength
W = Weakness
IN-SCHOOL ON-SITE/COMMUNITY
(Skill acquisition level) (Pre-employment level)
WORKSITE: RESTAURANTS/FOOD SERVICE / MAPP / SI
VP / I
NP / Task Analysis / MA
PP / SI
VP / I
NP / Task Analysis
SKILL AREA: BUS HELP ____STRENGTH ____WEAKNESS / S / W / S / W
1. Clean tables and chairs
2. Clean container jars
3. Wipe & place flip menus
4. Fold napkins
5. Fill up napkin holders
6. Label table containers
7. Fill table containers with ingredients
8. Place containers on tables correctly
9. Bus tables of dishes
10. Clean trays
11. Dust lights
12. Empty water containers in kitchen
13. Fold pizza boxes
14. Put happy meal toys in boxes
15. Clean waitress station
SKILL AREA: DISHWASHER DUTIES ____STRENGTH ____WEAKNESS
1. Use dish washer to wash dishes & pans
2. Stock dishes in appropriate area
SKILL AREA: CUSTODIAL DUTIES ____STRENGTH ____WEAKNESS
1. Clean windows
2. Clean restrooms
3. Sweep floors
4. Mop floors
SKILL AREA: SET-UP DUTIES _____Strength _____Weakness
1. Polish silverware
2. Polish glasses & plates
3. Stock coolers
4. Do table setups for conference setting
WORKSITE OVERALL PERFORMANCE RATING
______STRENGTH / ______NEUTRAL / ______WEAKNESS
Comments: ______
______
______
WORKSITE SKILL RESPONSIBILITY CHECKLIST
Student: ______Date: ______
Training Site: ______Schedule: ______
Supervisor: ______Job Coach: ______
Please rate using letter that correctly describes students’ performance.
MA = Maximum Assistance SI = Semi-Independent I = Independent Skill/Task Analysis
PP = Physical Prompt Required VP = Verbal Prompt Required NP = Requires No Prompt S = Strength
W = Weakness
IN-SCHOOL ON-SITE/COMMUNITY
(Skill acquisition level) (Pre-employment level)
WORKSITE: RETAIL STORES / MAPP / SI
VP / I
NP / Task Analysis / MA
PP / SI
VP / I
NP / Task Analysis
SKILL AREA: STOCKING ____STRENGTH ____WEAKNESS / S / W / S / W
1. Empty shelves & dust
2. Identify stock numbers on boxes
3. Match up shelves & stock items
4. Stock shelves with items
5. Place produce in bags
6. Weigh produce
7. Tie up produce in bags
8. Stock produce
9. Sort old produce
10. Replace misplaced items to correct aisles & shelves
11. Take empty boxes & plastic to stockroom
12. Throw away plastic in containers
13. Place empty boxes in compactor
14. Recycle boxes
SKILL AREA: BAGGING ____STRENGTH ____WEAKNESS
1. Bag groceries
2. Stock grocery bags
3. Return buggies to store
SKILL AREA: CUSTODIAL ____STRENGTH ____WEAKNESS
1. Sweep floors inside
2. Sweep floors outside
3. Clean cash registers
4. Take out trash
5. Clean window sills-both sides
6. Clean deli windows
7. Clean cooler doors
8. Clean produce counters
WORKSITE OVERALL PERFORMANCE RATING
______STRENGTH / ______NEUTRAL / ______WEAKNESS
Comments: ______
______
______
______
WORKSITE SKILL RESPONSIBILITY CHECKLIST
Student: ______Date: ______
Training Site: ______Schedule: ______
Supervisor: ______Job Coach: ______
Please rate using letter that correctly describes students’ performance.
MA = Maximum Assistance SI = Semi-Independent I = Independent Skill/Task Analysis
PP = Physical Prompt Required VP = Verbal Prompt Required NP = Requires No Prompt S = Strength
W = Weakness
IN-SCHOOL ON-SITE/COMMUNITY
(Skill acquisition level) (Pre-employment level)
WORKSITE: DEPARTMENT STORES / MAPP / SI
VP / I
NP / Task Analysis / MA
PP / SI
VP / I
NP / Task Analysis
SKILL AREA: STOCK/CLERICAL ____STRENGTH ____WEAKNESS / S / W / S / W
1. Check shelves for out of place items
2. Use store buggy
3. Straighten shelves
4. Pull items to front of shelves
5. Take items to correct aisle & shelve
6. Unpack merchandise
7. Price merchandise
8. Repack & stack boxes
9. Break down boxes for recycling
10. Stock shelves
11. Straighten clothes on shelves & rack
12. Hang clothes
13. Fold clothes
14. Pull plastic from new merchandise
15. Put out new merchandise
SKILL AREA: DELI DUTIES ____STRENGTH ____WEAKNESS
1. Bring donuts to display areas
2. Put icing on cupcakes
3. Put icing on brownies
4. Bag & tag breads
SKILL AREA: CUSTODIAL ____STRENGTH ____WEAKNESS
1. Wash dishes
2. Break down boxes for recycling
3. Take out trash
WORKSITE OVERALL PERFORMANCE RATING
______STRENGTH / ______NEUTRAL / ______WEAKNESS
Comments: ______
WORKSITE SKILL RESPONSIBILITY CHECKLIST
Student: ______Date: ______
Training Site: ______Schedule: ______
Supervisor: ______Job Coach: ______
Please rate using letter that correctly describes students’ performance.
MA = Maximum Assistance SI = Semi-Independent I = Independent Skill/Task Analysis
PP = Physical Prompt Required VP = Verbal Prompt Required NP = Requires No Prompt S = Strength
W = Weakness
IN-SCHOOL ON-SITE/COMMUNITY
(Skill acquisition level) (Pre-employment level)
WORKSITE: MOTEL/HOTEL / MAPP / SI
VP / I
NP / Task Analysis / MA
PP / SI
VP / I
NP / Task Analysis
SKILL AREA: HOUSEKEEPING ____STRENGTH ____WEAKNESS / S / W / S / W
1. Fold wash cloths
2. Fold hand towels
3. Fold bath towels
4. Stack towels by size
5. Fold rugs
6. Stack rugs on table
7. Vacuum halls
8. Vacuum floors of rooms
9. Clean glass doors & windows
10. Dust rooms
11. Clean bathrooms
12. Clean mirrors
13. Put up shower curtains
14. Restock toiletries in rooms
15. Place clean linen on beds
16. Place comforters on beds
17. Take out trash
WORKSITE OVERALL PERFORMANCE RATING
______STRENGTH / ______NEUTRAL / ______WEAKNESS
Comments: ______
______
WORKSITE SKILL RESPONSIBILITY CHECKLIST
Student: ______Date: ______
Training Site: ______Schedule: ______
Supervisor: ______Job Coach: ______
Please rate using letter that correctly describes students’ performance.
MA = Maximum Assistance SI = Semi-Independent I = Independent Skill/Task Analysis
PP = Physical Prompt Required VP = Verbal Prompt Required NP = Requires No Prompt S = Strength
W = Weakness
IN-SCHOOL ON-SITE/COMMUNITY
(Skill acquisition level) (Pre-employment level)
WORKSITE: INDEPENDENT FACILITY / MAPP / SI
VP / I
NP / Task Analysis / MA
PP / SI
VP / I
NP / Task Analysis
SKILL AREA: CLERICAL ____STRENGTH ____WEAKNESS / S / W / S / W
1. Use copier/collate & staple
2. Make sets of copies
3. Stuff envelopes and stack
4. Sort forms
5. Sharpen pencils
6. Shred papers
7. Breakdown folders
8. Assemble folders
9. Break down binders
10. Assemble binders
11. Shred discs
12. Deactivate hard drives
WORKSITE OVERALL PERFORMANCE RATING
______STRENGTH / ______NEUTRAL / ______WEAKNESS
Comments: ______
______
______
WORKSITE SKILL RESPONSIBILITY CHECKLIST
Student: ______Date: ______
Training Site: ______Schedule: ______
Supervisor: ______Job Coach: ______
Please rate using letter that correctly describes students’ performance.
MA = Maximum Assistance SI = Semi-Independent I = Independent Skill/Task Analysis
PP = Physical Prompt Required VP = Verbal Prompt Required NP = Requires No Prompt S = Strength
W = Weakness
IN-SCHOOL ON-SITE/COMMUNITY
(Skill acquisition level) (Pre-employment level)
WORKSITE: WORKPLACE SOCIAL SKILLS / MAPP / SI
VP / I
NP / Task Analysis / MA
PP / SI
VP / I
NP / Task Analysis
SKILL AREA: Clerical ____STRENGTH ____WEAKNESS / S / W / S / W
1. Dresses appropriately for worksite
2. Grooming and hygiene appropriate
3. Greets supervisor/coworkers
4. Accepts supervision
5. Follows directions
6. Asks for assistance when needed
7. Accepts constructive criticism
8. Helps others when appropriate
9. Does not bully or boss others
10. Speaks appropriately to staff/coworkers
11. Demonstrates appropriate social behaviors
12. Does not use profanity in conversation
13. Listens to others when involved in conversation
14. Makes decisions appropriate to work environment
15. Can work with others to solve problems
16. Follows workplace safety regulations
17. Exits workplace appropriately
WORKSITE OVERALL PERFORMANCE RATING
______STRENGTH / ______NEUTRAL / ______WEAKNESS
Comments: ______
______