INDIVIDUAL SKILLS INVENTORY
CUSTOMER: DATE:
OTHER PARTICIPANTS:
1) Transportation available to the customer
Ride Share
Public Transportation
Private, individual transportation: Self Others
Multiple options
COMMENTS:
2)Weekly Hours Desired
1 – 9 hours per week
10 – 19 hours per week
20 – 29 hours per week
30 – 40 + hours or multiple options
COMMENTS:
3)Shifts Desired
Daytime shift only
Second shift only
Third shift only
Available for any shift
COMMENTS:
4)Financial
Any employment will negatively impact benefits/income source
Earnings must be less than amount specified in comment
Employment will not impact current benefits/income
Employment income must be at least amount noted in comment
COMMENTS:
5)Appearance
Personal hygiene and cleanliness are not independently managed
Minimal hygiene and cleanliness standards are self managed
Hygiene, cleanliness and appearance standards are self managed
High standards for hygiene, cleanliness and appearance are self managed
COMMENTS:
6)Peer Interactions
Does not participate in appropriate interactions with peers
Participates in limited interactions with peers
Participates effectively in frequent job essential interactions with peers
Initiates and manages frequent and detailed job essential interactions with peers
COMMENTS:
7)Supervisor Interactions
Does not participate in appropriate interactions with supervisor
Participates in limited interactions with supervisor
Participates effectively in frequent job essential interactions with supervisor
Initiates and manages frequent and detailed job essential interactions with supervisor
COMMENTS:
8)Receptive Communication
Understands known gestures and/or sounds after considerable practice
Understands basic gestures, signals and/or sounds
Understands simple phrases
Understands complex sentences
COMMENTS:
9)Expressive Communication Requirements
Known gestures and sounds are only understandable to others after considerable practice
Gestures or signals are recognizable
Uses simple phrases
Uses sentences
COMMENTS:
10)Social Behavior
One-to-one support needed for any community participation
Independent for leisure/recreation purposes only
Exhibits work-related social behaviors with occasional supports
Can carry out complex work-related and community social contacts
COMMENTS:
11)Learning Style
Hands-on practice over multiple practice sessions
Visual
Auditory
Both visual and auditory
Can adapt to all learning styles and combinations thereof
COMMENTS:
12)Reinforcement
Requires constantly communicated feedback and cueing
Requires high density environmental feedback
Requires occasional contrived feedback
Requires only naturally occurring feedback
COMMENTS:
13)Quality
Unaware of quality as a performance function
Aware of quality as a job expectation, but is not self managed
Quality is self managed for basic tasks
Initiates and manages quality for basic and complex aspects of the job
COMMENTS:
14)Sequencing
Unaware of sequencing as performance function
Aware of sequencing as a job expectation, but is not self managed
Sequencing is self managed for basic tasks
Initiates, manages and alters the sequence of multiple step tasks based on work flow
COMMENTS:
15)Pace
Unaware of pace as a performance function
Aware of pace as a job expectation, but is not self managed
Pace is self managed for basic task sequences
Initiates and manages pace for complex task duration and sequence
COMMENTS:
16)Attention to Task
Frequently off task even with supervision
On task only with direct supervision
On task with encouragement and direct prompting
Perseveres on tasks without prompting
COMMENTS:
17)Reading
Does not read
Recognizes characters (single numbers or letters) and pictures
Reads words and phrases
Reads simple sentences and documents
Reads complex documents
COMMENTS:
18)Written Communication
Does not use written communication
Writes/prints characters (single numbers or letters)
Records words and phrases in written form
Composes basic documents using proper spelling, grammar and punctuation
Composes complex, grammatically correct documents
COMMENTS:
19)Time
Unaware of time functions
Indentifies time of day activities (example: breaks and lunch)
Tells time by hour only
Demonstrates detailed time skills
COMMENTS:
20)Money
Does not demonstrate money concepts
Conducts money exchanges, but does not recognize the relative value of coins and bills
Recognizes the relative value of coins and bills, but does not make change
Conducts money exchanges and makes change
Conducts multiple money and credit exchanges
COMMENTS:
21)Copying Data
Does not record data
Copies numbers and letters but not in forms
Copies words and sentences into forms not requiring precise placement and sizing
Copies information into forms requiring precise placement and sizing
COMMENTS:
22)Comparing Objects
Does not make ‘different-same’ judgments of objects
Compares objects and makes ‘different-same’ judgments
Compares objects and makes judgments requiring classification into more than two groups or sequences
Compares objects again multi-level standards and assigns to groups based on degree of differentiation
COMMENTS:
23)Upper Body
Use of upper body (including trunk, arms, hands and fingers) severely limited in range of motion, frequency of use and/or precision of movement
Once positioned, can use upper body to perform work tasks within limited range of motion, frequency, and precision
Despite some limits in range of motion, frequency and precision, can use upper body to complete work tasks within performance standards
Upper body within normal limits for range of motion, frequency of use and precision
COMMENTS:
24) Lower Body
Use of lower body (including hips, legs and feet) severely limited in range of motion, frequency of use and/or precision of movement
Once positioned, can use lower body to perform work tasks within limited range of motion, frequency, and precision
Despite some limits in range of motion, frequency and precision, can use lower body to complete work tasks within performance standards
Lower body within normal limits for range of motion, frequency of use and precision
COMMENTS:
25)Stand/Sit/Walk
Does not have consistent ability to maintain any work position for periods between work breaks
Can work in one position only
Must be able to change position frequently and without regard to workflow
Can adjust work position strictly according to demands of workflow
COMMENTS:
26)Lifting
No lifting at all
Lifts objects weighing less than 10 lbs
Lifts objects weighing less than 20 lbs
Lifts objects weighing up to and more than 20 lbs
COMMENTS:
27)Hearing
Unable to use hearing to perform any job tasks
Has limitations using auditory discrimination for one or more of the following tasks:
Telephone usage Conversation Machine operation
Hearing is adequate for all tasks requiring telephone usage, conversation or machine operation
COMMENTS:
28)Vision
Unable to use vision to perform any job tasks
Has limitation in using vision for one or more of the following:
Near Acuity Distance Acuity Depth Perception
Color and Visual Fields
Vision is adequate for all tasks requiring near acuity, distance acuity, depth perception, color and visual fields
COMMENTS:
29)People
Unaware of other people in the environment
Works more effectively alone
Works more effectively in areas with small numbers of people
Works with and effectively manages any number of people in the environment
COMMENTS:
30)Medication (Specify all medications in comments)
Prescribed medications interfere with physical activities such as vision, attention, balance, etc
Prescribed medications have no significant side effects, but may be forbidden in some work situations
Prescribed medications control health situations such as allergies, but have no impact on work performance or rules
Does not have health conditions requiring medications
COMMENTS:
Individual Skills Inventory 3-2011