Progress Note Form
Staff Name:
First Name
Last Name
Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Start Time:
End Time:
Individual Supporting:
*
Meeting Location:
*
Service Plan year:
Outcome/Goal:
*
Service Strategies:
*
Assistance with Activities of Daily Living (such as getting dressed, eating, personal hygiene, etc.)
Assistance with Increasing Community Participation (such as daily errands, attending events, going to a restaurant, purchasing items, travel training, etc.)
Assistance with Increasing Independence (such as helping the individual learn to do laundry, cook, clean, dress, grocery shop, pay for items, etc.)
Assistance with On-the-Job Support (such as safety awareness, using the restroom, attending to tasks, lunch/breaks, etc.)
Assistance with Learning Activities (such as basic tutoring, support in attending a class, etc.)
Description of Activity:
*
Description of progress toward goals/objectives:
*
Description of behaviors and/or incidents
Additional Notes
Submit
Should be Empty: