Class/Section:
A. Generic skills:
1
Dates
A1 Personal BL 1 Qtr 2 Qtr 3 Qtr SE
1. Eats complete meal independently
2. While eating politely asks for food to be
passed
3. After eating empties plates in trash can and
washes it
4. Select food and order in a public dining
facility
5. Use toilet independently
6. Washes and dries hands after toileting or
when needed.
7. Close door of toilet for normal privacy in
toileting
8. Obtains help for any toileting problem
9. Ask the location of toilet in new situations
10. Choose the correct toilet f/m in a public
place.
11. Washes face with soap.
12. Dresses and undresses independently
13. Tie bow knot with a shoe laces.
14. Maintains self( Nail cutting, Haircut and
shoe polish) odoured free and groomed.
15. Combs hair including oiling and plating
16. Shaves properly/ maintains menstrual
hygiene
Any Other ( Please specify):
Total Scores
A2 Domestic
1. Moping and cleaning the living area/Work
station.
2. Makes bed independently
3. Dusting the household equipments
4. Arrange things in room /class/ work place
at appropriate place
5. Is able to On / off the gas stove
6. Cutting the vegetables and fruits
7. Cleaning the pulses and rice
8. Making tea and sandwich
9. Use of mixer juicer and grinder
10. Washing utensils
11. Arrangement of dining table for serving
food
12. Washing clothes. 2
13. Ironing the cloths and placing them
appropriate place
14. Mending cloths
Any Other ( Please specify):
Total Scores
A3 Communication
1. Follows directions/instructions
2 Answering questions after listening a story.
3 Response to jokes with expressions
4 Follows announcements with appropriate
response
5 Speaks in phrases and sentences
6 Communicate address and telephone number
if required.
7 Expresses feelings, likes and dislikes
(verbally and Non verbal)
8 Express his /her likes and dislikes.
9 Carries on Meaningful conversation with
other person
10 Maintaining telephonic conversation
11 Summarizes TV/Radio programs
Any Other ( Please specify):
Total Scores
A4 Social Skills
1. Greets others/ friends/superiors upon
meeting (verbally/non verbal)
2. Say sorry /thanks/please when required.
3. Complete given activity/task
4. Follow routine activities at home and work
station
5. Ask permission while entering or going out
from the classroom.
6. Uses items with permission that belongs to
others
7. Sharing possessions with others ( Classroom
/ home and community)
8. Appropriate interaction with opposite sex
comfortably.
9. Receives phone calls and passes massage to
appropriate person
10 Manages or Asks help if needed.
Any Other ( Please specify):
3
Total Scores
A5 Safety Skills
1. Use of sharp objects
2. Understanding environmental hazards
3. Understanding of safety precautions of fire
4. Understanding sign of danger
5. Understanding of safety precautions of
electricity.
6. Understanding traffic safety and signs
7. Use of first aid.
8 Follow safety measures while using
electronic equipments.
Any Other ( Please specify):
Total Scores
A6 Academics
Reading symbols of Community use:
1. (Police, Bank, ATM, Telephone booth
Restaurant, Post Office, Fire Service,
Hospital, Red Cross, Bus Stop/Railway
Station /Airport)
2. Reading own name and address.
3. Reading symbolic instructions
4. Reading two word phrases.
5. Reading number on measuring tape
meaningfully
6. Reading numbers on weigh measures
meaningfully
7. Reading price tags
8. Read menu card to order in a restaurant
9. Reading news paper
4
forms etc.
15 Listing the items required for shopping.
16 Writing the measurement of object.
17 Writing day /date and month
18 Writing a leave letter/form when required.
19 Numbers 1-100 meaningfully.
20 Money transactions up to Rs. 100
21 Saves money from earnings and gifts.
22 Operating bank account
23 Operates ATM
24 Use of calculator
25 Understand profit and loss
26 Billing the Ptoduct
Any Other ( Please specify):
Total Scores
A7 Community Orientation
1. Travels independently by public / private
transport in familiar route/place.
2. Goes on foot or bicycle to a familiar place
and back
3. Obeys traffic signals
4. Uses community facilities ( Police/
Railway station/Hospital/Bus Stand
and post office etc)
5. Avails services from Sampark center
Any Other ( Please specify):
Total Scores:
5
Quantification of Achievement:
S,No. Area Total BL 1st Qtr 2nd 3rd SE
Scores Qtr Qtr
A1 Personal (16) 80
A3 Communication (12) 60
A4 Social (10) 50
6
B. Work Related Skills:
7
C. Pre requisite Skills for Vocational Training
Name of Student: Age:
Sex: IQ:
Total Scores
8
C. Pre requisite Skills for Vocational Training
Name of Student: Age:
Sex: IQ:
Total Scores
9
C. Pre requisite Skills for Vocational Training
Name of Student: Age:
Sex: IQ:
Total Scores
10
C. Pre requisite Skills for Vocational Training
Name of Student: Age:
Sex: IQ:
Total Scores
Score Pattern:- 0 (Dependent/Not Exposed/Not applicable) , 1 (Physical Prompt), 2
(Modelling), 3 (Verbal Prompt), 4 (Cueing) , 5 (Independent)
11
C. Pre requisite Skills for Vocational Training
Name of Student: Age:
Sex: IQ:
Total Scores
12
C. Pre requisite Skills for Vocational Training
Name of Student: Age:
Sex: IQ:
Total Scores
13
C. Pre requisite Skills for Vocational Training
Name of Student: Age:
Sex: IQ:
Total Scores
14
C. Pre requisite Skills for Vocational Training
Name of Student: Age: Sex:
Trade: Carpentry
S.N. Items / Section BL 1st 2nd 3rd SE
Qtr Qtr Qtr
1 Identification of measuring tape
2 Use of Measuring Tape
3 Identification of gazes
4 Use of Gazes
5 Identification of level (Water)
6 Use of Levels
7 Identification of Chisels (Tesi)
8 Use of Chisels
9 Identification of Saw (different sizes)
10 Use of Saw
11 Identification of Adge (different sizes
12 Use of Adges
13 Identification of Wood planer (different sizes)
14 Use of Wood planer (different sizes)
15 Identification of Iron planer (different sizes)
16 Use of Iron Planers
17 Identification of Drill (Electrical and manual)
18 Use of Drill
19 Identification of Different types of bits
20 Use of Different sizes of bits
21 Identification of Vices and cramps
22 Use of Vices and cramps
23 Identification of Hammers and types of nails
24 Use of Hammers and types of nails.
25 Identification of tools store.
26 Storing of tools and equipments in a safe manner
27 Save the equipments from water, dust and fire.
28 Sharpening of tools
29 Rubbing the wood with sand paper
30 Nailing/un nailing/nut bolting/screwing/
nscrewing by using appropriate tool.
31 Switching /un switching electrical equipments.
32 Ply and cenmica discrimination
33 To cut the size of bid for photo frames
Any Other ( Please specify):
Total Scores
15
Total Scores:
Total Scores
Graphical Presentation:
16