WORKSITE SKILL RESPONSIBILITY CHECKLIST
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1 WORKSITE SKILL RESPONSIBILITY CHECKLIST Student: Training Site: Supervisor: Date: Schedule: Job Coach: Please rate using letter that correctly describes students performance. MA = Maximum Assistance SI = Semi-Independent I = Independent PP = Physical Prompt Required VP = Verbal Prompt Required NP = Requires No Prompt Skill/Task Analysis S = Strength W = Weakness IN-SCHOOL ON-SITE/COMMUNITY (Skill acquisition level) (Pre-employment level) WORKSITE: RESTAURANTS/FOOD SERVICE MA PP SI VP I NP Task Analysis MA PP SI VP I NP Task Analysis SKILL AREA: BUS HELP STRENGTH WEAKNESS S W S W 1. Clean tables and chairs 2. Clean container jars 3. Wipe & place flip menus 4. Fold napkins 5. Fill up napkin holders 6. Label table containers 7. Fill table containers with ingredients 8. Place containers on tables correctly 9. Bus tables of dishes 10. Clean trays 11. Dust lights 12. Empty water containers in kitchen 13. Fold pizza boxes 14. Put happy meal toys in boxes 15. Clean waitress station SKILL AREA: DISHWASHER DUTIES STRENGTH WEAKNESS 1. Use dish washer to wash dishes & pans 2. Stock dishes in appropriate area SKILL AREA: CUSTODIAL DUTIES STRENGTH WEAKNESS 1. Clean windows 2. Clean restrooms
2 3. Sweep floors 4. Mop floors SKILL AREA: SET-UP DUTIES Strength Weakness 1. Polish silverware 2. Polish glasses & plates 3. Stock coolers 4. Do table setups for conference setting WORKSITE OVERALL PERFORMANCE RATING STRENGTH NEUTRAL WEAKNESS Comments:
3 WORKSITE SKILL RESPONSIBILITY CHECKLIST Student: Training Site: Supervisor: Date: Schedule: Job Coach: Please rate using letter that correctly describes students performance. MA = Maximum Assistance SI = Semi-Independent I = Independent PP = Physical Prompt Required VP = Verbal Prompt Required NP = Requires No Prompt Skill/Task Analysis S = Strength W = Weakness IN-SCHOOL ON-SITE/COMMUNITY (Skill acquisition level) (Pre-employment level) WORKSITE: RETAIL STORES MA PP SI VP I NP Task Analysis MA PP SI VP I NP Task Analysis SKILL AREA: STOCKING STRENGTH WEAKNESS S W S W 1. Empty shelves & dust 2. Identify stock numbers on boxes 3. Match up shelves & stock items 4. Stock shelves with items 5. Place produce in bags 6. Weigh produce 7. Tie up produce in bags 8. Stock produce 9. Sort old produce 10. Replace misplaced items to correct aisles & shelves 11. Take empty boxes & plastic to stockroom 12. Throw away plastic in containers 13. Place empty boxes in compactor 14. Recycle boxes SKILL AREA: BAGGING STRENGTH WEAKNESS 1. Bag groceries 2. Stock grocery bags 3. Return buggies to store SKILL AREA: CUSTODIAL STRENGTH WEAKNESS 1. Sweep floors inside 2. Sweep floors outside
4 3. Clean cash registers 4. Take out trash 5. Clean window sills-both sides 6. Clean deli windows 7. Clean cooler doors 8. Clean produce counters WORKSITE OVERALL PERFORMANCE RATING STRENGTH NEUTRAL WEAKNESS Comments:
5 WORKSITE SKILL RESPONSIBILITY CHECKLIST Student: Training Site: Supervisor: Date: Schedule: Job Coach: Please rate using letter that correctly describes students performance. MA = Maximum Assistance SI = Semi-Independent I = Independent PP = Physical Prompt Required VP = Verbal Prompt Required NP = Requires No Prompt Skill/Task Analysis S = Strength W = Weakness IN-SCHOOL ON-SITE/COMMUNITY (Skill acquisition level) (Pre-employment level) WORKSITE: DEPARTMENT STORES MA SI I Task MA SI I Task PP VP NP Analysis PP VP NP Analysis SKILL AREA: STOCK/CLERICAL STRENGTH WEAKNESS S W S W 1. Check shelves for out of place items 2. Use store buggy 3. Straighten shelves 4. Pull items to front of shelves 5. Take items to correct aisle & shelves 6. Unpack merchandise 7. Price merchandise 8. Repack & stack boxes 9. Break down boxes for recycling 10. Stock shelves 11. Straighten clothes on shelves & rack 12. Hang clothes 13. Fold clothes 14. Pull plastic from new merchandise 15. Put out new merchandise SKILL AREA: DELI DUTIES STRENGTH WEAKNESS 1. Bring donuts to display areas 2. Put icing on cupcakes 3. Put icing on brownies 4. Bag & tag breads SKILL AREA: CUSTODIAL STRENGTH WEAKNESS
6 1. Wash dishes 2. Break down boxes for recycling 3. Take out trash WORKSITE OVERALL PERFORMANCE RATING STRENGTH NEUTRAL WEAKNESS Comments:
7 WORKSITE SKILL RESPONSIBILITY CHECKLIST Student: Training Site: Supervisor: Date: Schedule: Job Coach: Please rate using letter that correctly describes students performance. MA = Maximum Assistance SI = Semi-Independent I = Independent PP = Physical Prompt Required VP = Verbal Prompt Required NP = Requires No Prompt Skill/Task Analysis S = Strength W = Weakness IN-SCHOOL ON-SITE/COMMUNITY (Skill acquisition level) (Pre-employment level) WORKSITE: MOTEL/HOTEL MA PP SI VP I NP Task Analysis MA PP SI VP I NP Task Analysis SKILL AREA: HOUSEKEEPING STRENGTH WEAKNESS S W S W 1. Fold wash cloths 2. Fold hand towels 3. Fold bath towels 4. Stack towels by size 5. Fold rugs 6. Stack rugs on table 7. Vacuum halls 8. Vacuum floors of rooms 9. Clean glass doors & windows 10. Dust rooms 11. Clean bathrooms 12. Clean mirrors 13. Put up shower curtains 14. Restock toiletries in rooms 15. Place clean linen on beds 16. Place comforters on beds 17. Take out trash
8 WORKSITE OVERALL PERFORMANCE RATING STRENGTH NEUTRAL WEAKNESS Comments:
9 WORKSITE SKILL RESPONSIBILITY CHECKLIST Student: Training Site: Supervisor: Date: Schedule: Job Coach: Please rate using letter that correctly describes students performance. MA = Maximum Assistance SI = Semi-Independent I = Independent PP = Physical Prompt Required VP = Verbal Prompt Required NP = Requires No Prompt Skill/Task Analysis S = Strength W = Weakness IN-SCHOOL ON-SITE/COMMUNITY (Skill acquisition level) (Pre-employment level) WORKSITE: INDEPENDENT FACILITY MA SI I Task MA SI I Task PP VP NP Analysis PP VP NP Analysis SKILL AREA: CLERICAL STRENGTH WEAKNESS S W S W 1. Use copier/collate & staple 2. Make sets of copies 3. Stuff envelopes and stack 4. Sort forms 5. Sharpen pencils 6. Shred papers 7. Breakdown folders 8. Assemble folders 9. Break down binders 10. Assemble binders 11. Shred discs 12. Deactivate hard drives
10 WORKSITE OVERALL PERFORMANCE RATING STRENGTH NEUTRAL WEAKNESS Comments:
11 WORKSITE SKILL RESPONSIBILITY CHECKLIST Student: Training Site: Supervisor: Date: Schedule: Job Coach: Please rate using letter that correctly describes students performance. MA = Maximum Assistance SI = Semi-Independent I = Independent PP = Physical Prompt Required VP = Verbal Prompt Required NP = Requires No Prompt Skill/Task Analysis S = Strength W = Weakness IN-SCHOOL ON-SITE/COMMUNITY (Skill acquisition level) (Pre-employment level) WORKSITE: WORKPLACE SOCIAL SKILLS MA SI I Task MA SI I Task PP VP NP Analysis PP VP NP Analysis SKILL AREA: Clerical STRENGTH WEAKNESS S W S W 1. Dresses appropriately for worksite 2. Grooming and hygiene appropriate 3. Greets supervisor/coworkers 4. Accepts supervision 5. Follows directions 6. Asks for assistance when needed 7. Accepts constructive criticism 8. Helps others when appropriate 9. Does not bully or boss others 10. Speaks appropriately to staff/coworkers 11. Demonstrates appropriate social behaviors 12. Does not use profanity in conversation 13. Listens to others when involved in conversation 14. Makes decisions appropriate to work environment 15. Can work with others to solve problems 16. Follows workplace safety regulations 17. Exits workplace appropriately
12 WORKSITE OVERALL PERFORMANCE RATING STRENGTH NEUTRAL WEAKNESS Comments:
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