Part II - Assessment by Trusted Person

Ask someone else to complete this Part 2 assessment. The person who completes this section should be someone who knows you very well. They might be a family member, a teacher, a job coach, or a therapist.

Assessors Name: Relationship to JobTips user:

Directions: 1. Print out this assessment.

Date:

2. Read each question carefully. As you read each question, consider how the person you are assessing responds across all environments (home, school, public places, unfamiliar contexts, etc).

Read each question carefully. Circle A, B, or C for each item. A = Almost always B = Sometimes C = Rarely 3. Respond to each question as honestly as you can. 4. Add up your total number of As, Bs, and Cs when you are finished.

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Part II - Assessment by Trusted Person

(page 2)

Questions:
1. 2. 3. 4. 5. 6. 7. 8. 9. Responds to questions. Initiates conversations appropriately. Joins ongoing conversations appropriately. Changes conversation topics appropriately. Speaks clearly. Displays appropriate body language in conversations. Maintains appropriate physical distance in conversations. Demonstrates appropriate listening behaviors (i.e. faces speaker, nods head). Uses greetings. A A A A A A A A A A A A A A A A A B B B B B B B B B B B B B B B B B

Rarely

C C C C C C C C C C C C C C C C C

10. Uses farewells. 11. Selects appropriate conversational topics. 12. Avoids inappropriate conversational topics. 13. Uses telephone appropriately to give and obtain info. 14. Expresses frustration appropriately. 15. Expresses disagreement appropriately. 16. Acknowledges own errors / mistakes. 17. Apologizes for mistakes.

Copyright 2011 www. Do2Learn.com

Part II - Assessment by Trusted Person

(page 3)

Questions:
18. Works comfortably in group tasks. 19. Accepts the ideas / suggestions of others. 20. Accepts corrective feedback appropriately. 21. Corrects mistakes based on feedback. 22. Appropriately tolerates being told no. things (instructions, directions, events) to other people 23. Explains in a clear, organized manner. 24. Demonstrates respect for other peoples property. 25. Appropriately seeks assistance when needed. 26. Seeks clarification when needed. 27. Offers assistance to others. 28. Dresses appropriately given context. 29. Maintains personal hygiene. 30. Avoids unusual behaviors, self-stimulatory behaviors in public. 31. Engages in appropriate activities during unstructured breaks. A A A A A A A A A A A A A A B B B B B B B B B B B B B B

Rarely

C C C C C C C C C C C C C C

Total number of:

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