These forms help you document (1) where challenges exist (Challenges in daily living) and (2) what the person’s goals are (My goals). Ideally, you will complete these forms with the person that you are supporting. For information about using these forms, see Section 3: Developing a Plan: Customizing your plan.
Use this form to map out up to three goals, and the main challenges that get in the way of the person reaching those goals. For more information about using this form, see Section 3: Developing a plan: Pulling it all together
Use this form to record activities for a week. You can use this to start a conversation about what your relative is doing enough of, what would be good to do more of, and what activities he or she might want to start increasing. For more information about using this form, see Section 4: Getting started with environmental supports: Devices for recording and tracking progress.
Use this form to create a checklist with five to six activities that your relative plans to complete daily. Insert activity choices in the left hand column and check them off when completed. For more information about using this form, see Section 4: Getting started with environmental supports: Devices for recording and tracking progress.
Use this template to create a customized checklist of suggested supports for each activity with additional information about how your relative could use the supports in their own home. You’ll find a sample checklist for each activity in Section 5: Basic strategies for everyday living and Section 6: Strategies that go beyond basics.
Use this form to document the strategies that you and the person you're supporting have agreed to try: what has been working--and what hasn't; changes in strategies; items to buy. You'll find information about implementing and reviewing strategies in Section 7: Putting supports into practice.
A template for creating a wallet-sized card with address, phone and emergency contact information.