Self-Help Skills Progress Report
Report and evaluate progress in self-help skills for individuals. Please complete all relevant sections for an accurate assessment.
Individual's Full Name
*
First Name
Last Name
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessment Period
*
Please Select
Monthly
Quarterly
Bi-Annually
Annually
Other
Self-Help Skills Evaluation
*
Rows
Independent
Needs Assistance
Dependent
Dressing
1
2
3
Feeding
4
5
6
Personal Hygiene
7
8
9
Toileting
10
11
12
Grooming
13
14
15
Comments and Observations
Goals or Recommendations for Next Period
Evaluator's Name
*
First Name
Last Name
Submit Progress Report
Should be Empty: