Project SEARCH Intern Self-Preparation Assessment

I arrive at school, work, or activities every day with:

Clean and combed hairClean clothing and underwearBrushed teeth/oral hygieneDeodorant

I arrive at school, work, or activities every day with clean and combed hair:*

YesNoOther

Please explain:

I arrive at school, work, or activities every day with clean clothing and underwear:*

YesNoOther

Please explain:

I arrive at school, work, or activities every day with brushed teeth/oral hygiene:*

YesNoOther

Please explain:

I arrive at school, work, or activities every day with deodorant:*

YesNoOther

Please explain:

How I dress

I wear appropriate clothing for the weatherI follow my school/work dress code

I wear appropriate clothing for the weather*

YesNoOther

Please explain:

I follow my school/work dress code*

YesNoOther

Please explain:

I am willing to follow the designated dress code of my employer including rules on appropriate clothing, shoes, facial hair, facial and body piercings, tattoos, jewelry, and fingernail polish and length:*

YesNoOther

Please explain:

I am willing to follow the designated dress code of my employer including rules on:

If you have any notes for appearance and professional presentation, put them here:

Please select all that apply

I have reliable transportation to get to workI have my own car, driver’s license and insuranceI know how to use public transportationI’m willing to learn to use public transportationI use public transportation and can make my own ride appointmentsI use public transportation and another person schedules my ride appointmentsI have a family member/ care provider who is willing to provide on-going transportationOther transportation options

I have reliable transportation to get to work*

YesNoOther

Please explain:

I have my own car, driver’s license and insurance*

YesNoOther

Please explain:

I know how to use public transportation*

YesNoOther

Please explain:

I’m willing to learn to use public transportation*

YesNoOther

Please explain:

I use public transportation and can make my own ride appointments*

YesNoOther

Please explain:

I use public transportation and another person schedules my ride appointments*

YesNoOther

Please explain:

I have a family member/ care provider who is willing to provide on-going transportation*

YesNoOther

Please explain:

I have other transportation options*

YesNoOther

Please explain:

If you have any notes about transportation, put them here:

Please select all that apply

I do not hold hands, hug, kiss, flirt, or touch people in private areas at school or work (or other inappropriate times)I do not swear or use profanity in a school or work settingI show respect to my peers and co-workersI work cooperatively with othersI accept correction and criticism without a negative reactionI have lost my temper at school, work or in a community place

I do not hold hands, hug, kiss, flirt, or touch people in private areas at school or work (or other inappropriate times)*

YesNoOther

Please explain:

I do not swear or use profanity in a school or work setting*

YesNoOther

Please explain:

I show respect to my peers and co-workers*

YesNoOther

Please explain:

I work cooperatively with others*

YesNoOther

Please explain:

I accept correction and criticism without a negative reaction*

YesNoOther

Please explain:

I have lost my temper at school, work or in a community place*

YesNoOther

I have had aggressive behavior in a community place:

Screaming or yellingHitting/punching/kickingSpittingThrowing things/attacking things

If you have any notes about social and behavior skills, put them here:

Please select all that apply

I respond when someone speaks or asks questionsI make eye contactI use an appropriate tone of voiceI engage in appropriate conversation in a school or work environmentI use a cell phone and electronics and can follow rules with them at school or work. Examples: not using the phone while working, using headphones while on break.I talk about the same topics over and over again

I respond when someone speaks or asks questions*

YesNoOther

Please explain:

I make eye contact*

YesNoOther

Please explain:

I use an appropriate tone of voice*

YesNoOther

Please explain:

I engage in appropriate conversation in a school or work environment*

YesNoOther

Please explain:

I use a cell phone and electronics and can follow rules with them at school or work. Examples: not using the phone while working, using headphones while on break.*

YesNoOther

Please explain:

I talk about the same topics over and over again*

YesNoOther

Please explain:

I use appropriate body language in a school or work environment. (i.e., no inappropriate hand gestures, sitting appropriately in a chair / posture, and respecting personal space)*

YesNoOther

Please explain:

I use appropriate body language in a school or work environment:

No inappropriate hand gesturesSitting appropriately in a chair / postureRespecting personal space

Please select all that apply

I am easily understood by othersI sometimes have trouble getting my message across to othersI use adaptive equipment to communicateI am willing to learn to use adaptive equipment to communicate if appropriateI use an interpreter and/or use sign language to communicate

I am easily understood by others*

YesNoOther

Please explain:

I sometimes have trouble getting my message across to others*

YesNoOther

Please explain:

I use adaptive equipment to communicate*

YesNoOther

Please explain:

I am willing to learn to use adaptive equipment to communicate if appropriate*

YesNoOther

Please explain:

I use an interpreter and/or use sign language to communicate*

YesNoOther

Please explain:

If you have any notes about communication skills, put them here:

I participate in organized group activities:*

Which sports?

I like to exercise on my own (walking, running, biking, etc.)*

YesNoOther

Please explain:

I exercise this many times a week for at least 30 minutes each time

I like sit-down activities such as:*

I have the following hobbies:

Project SEARCH Intern Self-Preparation Assessment

Commitment to Community Employment

Job Readiness

Independent Daily Living and Self Care Skills

Appearance and Professional Presentation

Transportation

Appropriate Social and Behavior Skills

Interpersonal Communication

Verbal Communication

Recreational Activities

Physical Limitations

Production Rate and Work Quality

Employability Skills

Prior Work Experience

Computer/Electronic Skills

Problem Solving and Conflict Resolution