Life Skills Observation Form
Use this Life Skills Observation Form to record and assess everyday functional skills. Please complete all sections accurately for a comprehensive observation.
Observer's Full Name
*
First Name
Last Name
Date of Observation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Observed Person's First Name
*
Relationship to Observed Person
*
Please Select
Parent/Guardian
Teacher
Support Staff
Self
Other
Skill Area Observed
*
Please Select
Personal Hygiene
Meal Preparation
Money Management
Time Management
Social Interaction
Household Tasks
Community Access
Other
How often does the observed person demonstrate this skill?
*
Always
Often
Sometimes
Rarely
Never
Level of Independence in this Skill
*
Dependent
1
2
3
4
Independent
5
1 is Dependent, 5 is Independent
Quality of Skill Performance
*
1
2
3
4
5
Additional Observations or Notes
Are follow-up actions or additional support needed?
*
Yes
No
Not Sure
Submit Observation
Should be Empty: