Information

  • Document No.

  • Section

  • Name

  • Week Beginning

  • Prepared by

  • SOCIAL AND BEHAVIOURAL

  • Assistance to achieve a range of social behavioural and emotional abilities that are required in most situations.
    Example
    Maintain friendly and cooperative relationships.
    Interacting with people confidently and appropriately.
    Behaving appropriately controlling anger and frustration.
    Coping with work-related stress and pressure.
    Maintaining a positive outlook and mood.
    Maintaining personal hygiene grooming and dress.

  • Date

  • Number of prompts

  • Time Taken

  • Comments

  • COGNITIVE

  • Assistance required to learn work-related tasks, Solve problems, make decisions, understand instructions and remember tasks and instructions

  • Date

  • Number of prompts

  • Time Taken

  • Comments

  • VOCATIONAL

  • Assistance to achieve skills and attitudes that are important in employment settings such as:
    Understanding the basic requirements of employment.
    Work productivity and work quality.
    Ability to work under supervision on a task.
    Appropriate response to supervision and instructions.
    Attendance and punctuality.
    Compliance with safety requirements.
    Awareness and acceptance of own abilities and limitations.
    Motivation.

  • Date

  • Number of prompts

  • Time Taken

  • Comments

  • PHYSICAL AND PERSONAL CARE

  • Assistance required to manipulate and move objects, move safely around the work environment, set up and arrangement work environment, equipment and materials and attend personal-care needs.
    Assistance required with personal-care such as toileting, preparing and consuming food and drinks in the workplace, managing medication and transferring to and from a wheelchair.

  • Date

  • Number of prompts

  • Time Taken

  • Comments

  • COMMUNICATION

  • Abilities associated with using an understanding language (spoken, signed, or other communication), including hearing, comprehension, speech / expressive language, use of a language other than English, appropriate use of language and language used in the workplace.

  • Date

  • Number of prompts

  • Time Taken

  • Comments

  • WORKPLACE ENVIRONMENT

  • Assistance provided in assessing modifying the workplace, job redesign selection of adaptive equipment, training the supported employee and co-workers in the use of adaptive equipment or technology and supporting co-workers and employers to adjust to and accommodate the supported employees ability and workplace support needs.

  • Date

  • Number of prompts

  • Time Taken

  • Comments

  • SPECIAL ASSISTANCE

  • Additional assistance for support that may be required by some people.
    For example physical or nonphysical intervention to prevent injury to self or others, first aid treatment for medical conditions such as epilepsy or asthma and counselling of interventions for mental health related episodes.

  • Date

  • Number of prompts

  • Time Taken

  • Comments

  • OTHER ASSISTANCE

  • For example advising or counselling the supported employees family, assisting the supported employee in matters involving other agencies, such a centre link, liaising with other agencies and treating professionals, transporting the supported employee to and from work, interpreter assistance, English language or literacy training.

  • Date

  • Number of prompts

  • Time Taken

  • Comments

  • VARIABLE ASSISTANCE

  • Identifies the size and frequency of fluctuations or variations in the supported employees assistance needs, and any evidence that the supported employee has an episodic or deteriorating condition.

  • Date

  • Number of prompts

  • Time Taken

  • Comments

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.