| Emergency and Safety Skills | Fully Independent |
Partially Independent |
Not an Expectation or Not Applicable |
For any answer of "Partially Independent" or "Not an Expectation": Describe Type of Support Needed and Who Provides This |
|---|---|---|---|---|
| Recognizing smoke alarm and other warning sirens | ||||
| Evacuating unassisted in case of emergency | ||||
| Calling 911, and willing to do so if needed | ||||
| Identifying what is and is not an emergency | ||||
| Communicating with emergency responders | ||||
| Identifying guardian (if applicable) and contacting when needed for guidance | ||||
| Spending one or more nights home alone | ||||
| Locking and unlocking doors | ||||
| Knowing what to do if locked out of home/apartment | ||||
| Recognizing when not to open the door or let strangers in | ||||
| Identifying and avoiding personal allergies (nuts, bees, etc.) | ||||
| Managing any allergic reactions, asthma, etc. | ||||
| Caring for minor wounds | ||||
| Seeking out trusted adults when in need of help | ||||
| Knowing when to use social security number and how to keep it safe | ||||
| Understanding the consequences of signing a contract | ||||
| Protecting privacy online; not putting self or others in danger | ||||
| Avoiding harmful or dangerous situations | ||||
| Recognizing junk mail, spam email, scam phone calls or texts |
| Healthcare Skills | Fully Independent |
Partially Independent |
Not an Expectation or Not Applicable |
For any answer of "Partially Independent" or "Not an Expectation": Describe Type of Support Needed and Who Provides This |
|---|---|---|---|---|
| Taking medication without supervision and on time | ||||
| Refilling prescriptions | ||||
| Not taking someone else's medication | ||||
| Finding over the counter medication if needed | ||||
| Reading medication labels correctly and following instructions | ||||
| Recognizing and addressing needs related to cold, flu, fever, and digestive problems | ||||
| Recognizing when to go to the emergency room, urgent care, or schedule an appointment with a doctor | ||||
| Knowing who to contact if not feeling well and following a plan for care | ||||
| Going to the doctor or dentist as needed (including transportation) | ||||
| Keeping a sleep schedule (7–10 hours/night) and not disturbing others at night | ||||
| Getting regular physical exercise | ||||
| In the event of accessing medical care without a support person available, indicate if able to handle independently: | ||||
| YES | NO | |||
| Can take own temperature using a thermometer and identify if fever exists | ||||
| Able to contact and get to urgent or emergency care | ||||
| Call a doctor and schedule an appointment | ||||
| Locate health insurance card or information | ||||
| Provide birthdate, height, and approximate weight | ||||
| Provide important medical information | ||||
| Sexual Health Skills | Fully Independent |
Partially Independent |
Not an Expectation or Not Applicable |
For any answer of "Partially Independent" or "Not an Expectation": Describe Type of Support Needed and Who Provides This |
|---|---|---|---|---|
| Taking care of menstrual periods; maintains and uses supplies | ||||
| Understanding consent, including how to refuse, give, and recognize consent | ||||
| Ability to confidently say no to peers or others | ||||
| Accessing and using various forms of contraceptives: birth control, condoms, etc. | ||||
| Recognizing public spaces versus private spaces | ||||
| Recognizing private behavior versus public behavior |
| Hygiene and Personal Appearance | Fully Independent |
Partially Independent |
Not an Expectation or Not Applicable |
For any answer of "Partially Independent" or "Not an Expectation": Describe Type of Support Needed and Who Provides This |
|---|---|---|---|---|
| Brushing teeth daily | ||||
| Showering daily | ||||
| Washing hair | ||||
| Grooming (hair care, nail care, etc.) | ||||
| Shaving as needed | ||||
| Using deodorant daily | ||||
| Toileting | ||||
| Washing hands after using restroom | ||||
| Dressing self | ||||
| Choosing appropriate and clean clothes to wear based on weather and occasion |
| Laundry Skills | Fully Independent |
Partially Independent |
Not an Expectation or Not Applicable |
For any answer of "Partially Independent" or "Not an Expectation": Describe Type of Support Needed and Who Provides This |
|---|---|---|---|---|
| Putting dirty clothes in hamper or other appropriate place | ||||
| Operating a washer and dryer | ||||
| Cleaning lint screen after each drying cycle | ||||
| Folding clothes and putting clothes away | ||||
| Washing laundry weekly including sheets and towels |
| Nutrition and Dietary Skills | Fully Independent |
Partially Independent |
Not an Expectation or Not Applicable |
For any answer of "Partially Independent" or "Not an Expectation": Describe Type of Support Needed and Who Provides This |
|---|---|---|---|---|
| Eating | ||||
| Maintaining a generally balanced and nourishing diet | ||||
| Recognizing the difference between healthy and unhealthy foods and beverages | ||||
| Managing personal needs regarding food allergies, sensitivities, or special diet | ||||
| Preparing daily meals: breakfast, lunch, and dinner | ||||
| Following a simple recipe, using measuring cups and spoons | ||||
| Planning weekly meals for self and making a grocery list | ||||
| Locating items in the store or online and purchasing within budget |
| Kitchen and Food Safety Skills | Fully Independent |
Partially Independent |
Not an Expectation or Not Applicable |
For any answer of "Partially Independent" or "Not an Expectation": Describe Type of Support Needed and Who Provides This |
|---|---|---|---|---|
| Washing hands before eating and preparing food | ||||
| Cleaning up following each meal or snack | ||||
| Washing and putting away dishes | ||||
| Loading and unloading dishwasher | ||||
| Sanitizing kitchen counters and sink | ||||
| Sweeping and mopping kitchen floors | ||||
| Storing perishable items in the refrigerator | ||||
| Recognizing if food is bad (expired dates, color, smell, etc.) and not eating it | ||||
| Using blades safely: sharp knives, grater, can opener | ||||
| Using small appliances: microwave, toaster, coffee maker, air fryer | ||||
| Using stovetop and/or oven (indicate if only one is used) | ||||
| Remembering to turn off stovetop and/or oven after use |
| Money Management | Fully Independent |
Partially Independent |
Not an Expectation or Not Applicable |
For any answer of "Partially Independent" or "Not an Expectation": Describe Type of Support Needed and Who Provides This |
|---|---|---|---|---|
| Making own purchases with card or cash | ||||
| Comparing prices when shopping (identify sales, use coupons) | ||||
| Recognizing the difference between needs and wants | ||||
| Saving money for future needs | ||||
| Determining available funds (bank account, EBT, etc.) | ||||
| Planning for total amount of bills owed (rent, utilities, other expenses) | ||||
| Managing benefits (Medicaid, Social Security, etc.) |
| Household Skills | Fully Independent |
Partially Independent |
Not an Expectation or Not Applicable |
For any answer of "Partially Independent" or "Not an Expectation": Describe Type of Support Needed and Who Provides This |
|---|---|---|---|---|
| Following a routine or system to accomplish cleaning tasks (calendar, check list, etc.) | ||||
| Identifying appropriate cleaning products/tools to use for different cleaning jobs | ||||
| Keeping trash picked up and in trash can | ||||
| Recognizing full container (or smell) and taking trash bag to dumpster | ||||
| Maintaining common spaces: dust, declutter, and clean as needed | ||||
| Cleaning floors: using a vacuum, broom, or mop | ||||
| Maintaining bedroom: free of food or trash, cleaning surfaces and floor | ||||
| Maintaining bedding: removing sheets and pillow cases, washing, making bed | ||||
| Cleaning bathroom sink/counter/mirror | ||||
| Cleaning toilet | ||||
| Cleaning bathtub/shower | ||||
| Knowing how to get rid of and avoid insects or rodents | ||||
| Identifying and reporting maintenance issues promptly (e.g., leaks, broken items, non-working appliances, or utilities) |
| Relational and Self-Advocacy Skills | Fully Independent |
Partially Independent |
Not an Expectation or Not Applicable |
For any answer of "Partially Independent" or "Not an Expectation": Describe Type of Support Needed and Who Provides This |
|---|---|---|---|---|
| Following social boundaries with different groups: family, friends, coworkers, strangers | ||||
| Respecting others' personal space, time, and property | ||||
| Being courteous to others and respecting differences | ||||
| Avoiding inappropriate touching of others or self | ||||
| Taking responsibility for own choices (and accompanying consequences) | ||||
| Communicating needs and requesting assistance | ||||
| Engaging in back-and-forth conversation with others | ||||
| Effectively managing frustration, anger, boredom, excitement, and other emotions | ||||
| Choosing a variety of appropriate free time activities | ||||
| Participating in recreation and leisure activities with peers | ||||
| Taking action when feeling lonely or wanting social connection | ||||
| Participating in preferred community activities (clubs, church, gatherings, etc.) | ||||
| Using problem-solving strategies and compromising | ||||
| Working to develop and maintain supportive relationships | ||||
| Maintaining emotional wellbeing | ||||
| Making friends and keeping friends (male and female) | ||||
| Resolving conflict between self and others, or seeking assistance to do so | ||||
| Identifying relationships that may be harmful or dangerous, or if someone is taking advantage | ||||
| Recognizing and reporting abuse, neglect, or danger | ||||
| Recognizing the difference between an acquaintance and a friend | ||||
| Saying no to negative influences or unsafe choices | ||||
| Accepting others' boundaries and no for an answer | ||||
| Advocating for self | ||||
| Generally recognizing what actions are against the law | ||||
| Applying appropriate phone/texting/posting manners and boundaries | ||||
| Using electronics (phone, computer, video games, etc.) responsibly | ||||
| Protecting self from exploitation in person and online | ||||
| Developing a realistic plan, with appropriate steps to achieve a goal | ||||
| Following a plan and steps involved to move toward a goal |
| Community Navigation and Employment Skills | Fully Independent |
Partially Independent |
Not an Expectation or Not Applicable |
For any answer of "Partially Independent" or "Not an Expectation": Describe Type of Support Needed and Who Provides This |
|---|---|---|---|---|
| Operate personal vehicle: car, motorized scooter, other (please describe) | ||||
| Use public transportation: set up and ride to/from locations | ||||
| Ride a bike/trike and follow bike safety | ||||
| Cross streets safely: at stoplights, 4-way stops, stop signs | ||||
| Look for and avoid moving traffic: parking lots, sidewalks, bike paths, etc. | ||||
| Identify and follow safety signs (e.g., caution, do not enter, danger, etc.) | ||||
| Using adaptive equipment or other tools (please describe) | ||||
| Aware and alert in unfamiliar settings and when dark | ||||
| Keeping cell phone on person when out of house/apartment | ||||
| Completing forms: registration, application, etc. | ||||
| Knowing types of jobs that are a fit based on skills, needs, and income | ||||
| Looking for employment and knowing how to get assistance with this | ||||
| Learning job tasks and maintaining stamina | ||||
| Completing work-related tasks with acceptable quality | ||||
| Completing work-related tasks with acceptable speed | ||||
| Interacting with co-workers and supervisors | ||||
| Asking questions and accepting constructive feedback | ||||
| Transitioning to new job assignment with ease |
| Communication, Time Management and Scheduling | Fully Independent |
Partially Independent |
Not an Expectation or Not Applicable |
For any answer of "Partially Independent" or "Not an Expectation": Describe Type of Support Needed and Who Provides This |
|---|---|---|---|---|
| Verbal communication — receiving and speaking: greetings, simple instructions, etc. | ||||
| Reading — newsletter, events calendar, task or grocery list, etc. | ||||
| Writing — personal information, notes, lists | ||||
| Using picture-based communication in place of printed text | ||||
| Using an adaptive communication device (please describe) | ||||
| Using a cell phone (or landline) for incoming and outgoing calls | ||||
| Sending and receiving text messages | ||||
| Checking and responding to personal voicemail | ||||
| Checking and responding to personal email | ||||
| Using apps on smartphone or tablet | ||||
| Following an electronic or paper schedule for events or chores | ||||
| Telling time (quiet hours, time for work/bus, what time to arrive for a scheduled appointment/event, etc.) | ||||
| Setting and recognizing an alarm/alert on phone, watch, or clock | ||||
| Managing morning routine: Get up and ready on time without assistance | ||||
| Scheduling and attending personal appointments (haircut, activity, volunteering) | ||||
| Recognizing availability or conflicts when adding to or editing personal calendar | ||||
| Reviewing and identifying activities of interest and using Sign Up Genius | ||||
| Arriving on time for commitments |
Great job thinking about all of those skills! Celebrate the areas where you notice success.
How did you grow the skills you have now? What strategies can you use to grow success in other areas? Some things might always involve support from others — and that is okay.
If there are skills that would be important to develop, consider if they have never been expected. This is the time to set some small, achievable goals.
Thank you for taking the time to complete this assessment. We trust you will find this information useful as you plan for independent living.