Fillable Independent Living Skills (ILS) Checklist

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Independent Living Skills (ILS) Checklist

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Independent Living Skills (ILS) Checklist
Low Incidence Outreach
702 W. Kalamazoo St.
Lansing, MI 48915
www.mdelio.org
Updated 09.21.2018
Table of Contents
ILS Checklists
I. Dressing Checklist 01
II. Hygiene Checklist 04
III. Eating Skills Checklist 08
IV. Cooking Skills Checklist 12
V. Household Chores Checklist 17
VI. Basic Household Repairs Checklist 21
VII. Laundry Skills Checklist 23
VIII. Organizational Skills Checklist 26
IX. Safety Emergency Procedures Checklist 29
X. Telephone Skills Checklist 34
XI. Time Concepts Checklist 37
XII. Money Skills Checklist 40
XIII. Personal Information Checklist 44
XIV. Medical Health Care Checklist 47
XV. Social Skills Checklist 50
XVI. Self-Advocacy Checklist 54
XVII. Orientation and Mobility Checklist 58
Independent Living Skills (ILS)
I. Dressing Checklist
Student Name:
I = Independent (no verbal or physical assistance needed)
S = With supervision (independent with monitoring for safety)
VA = Verbal assistance
MA = Minimal assistance (two verbal or physical prompts or fewer)
WA = With assistance (more than two verbal/physical prompts)
CU = Concept understood
Date of Birth:
Note: Assessments should take place when students are exiting each grade level.
Assessment Key
# Dressing Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
- Date Tasks Assessed
1 Describe clothing on self (Preschool)
2 Describe belongings (Preschool)
3 Identify own belongings (Preschool)
4 Ensure privacy when dressing and undressing (2nd Grade)
5 Participate in clothing purchase (6th Grade)
6 Know the size of own clothing/shoes (6th Grade)
7 Dress self (2nd Grade)
8 Awareness of proper t of clothing (8th Grade)
9 Put on all outerwear (2nd Grade)
Low Incidence Outreach
702 W. Kalamazoo St.
Lansing, MI 48915
www.mdelio.org
Independent Living Skills Checklist: Dressing Updated 09.21.2018
01
# Dressing Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
10 Differentiate between front/back of clothing when difcult to tell apart (4th Grade)
11 Orient articles of clothing (4th Grade)
12 Loop belt through belt loops (4th Grade)
13 Tie own shoes (2nd Grade)
14 Lace shoes (6th Grade)
15 Use snaps, buttons, zippers, and laces of all dress-wear (12th Grade)
16 Put on and remove bra (8th Grade)
17 Put on athletic supporter (8th Grade)
18 Tie a necktie or bow tie (10th Grade)
19 Create system for labeling/matching (6th Grade)
20 Use system for labeling/matching clothing (4th Grade)
21 Label or adapt own clothing to aid in care/selection (8th Grade)
22 Organize wardrobe for identication (8th Grade)
23 Color-coordinate clothing (8th Grade)
24 Plan and update own wardrobe (8th Grade)
25 Know complementary colors and styles (8th Grade)
26 Consider a variety of factors when deciding on clothing purchase (10th Grade)
Independent Living Skills Checklist: Dressing Updated 09.21.2018
02
# Dressing Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
27 Select/purchase articles of clothing, footwear, accessories, etc. (10th Grade)
28 Maintain order of personal items (8th Gradel)
29 Organize jewelry for identication (8th Grade)
30 Select and wear accessories for outt (10th Grade)
Dressing Checklist Notes
Independent Living Skills Checklist: Dressing Updated 09.21.2018
03
Independent Living Skills (ILS)
II. Hygiene Checklist
Student Name:
Date of Birth:
Note: Assessments should take place when students are exiting each grade level.
Assessment Key
I = Independent (no verbal or physical assistance needed)
S = With supervision (independent with monitoring for safety)
VA = Verbal assistance
MA = Minimal assistance (two verbal or physical prompts or fewer)
WA = With assistance (more than two verbal/physical prompts)
CU = Concept understood
# Hygiene Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
- Date Tasks Assessed
1 Use a familiar restroom (2nd Grade)
2 Ask for assistance to orient to unfamiliar restroom (2nd Grade)
3 Wash hands (Preschool)
4 Use a variety of towel dispensers/hand dryers (2nd Grade)
5 Use a variety of restroom xtures (2nd Grade)
6 Wash face (Preschool)
7 Wash own body parts (Preschool)
8 Run water for bath/shower (2nd Grade)
9 Drain tub (2nd Grade)
Low Incidence Outreach
702 W. Kalamazoo St.
Lansing, MI 48915
www.mdelio.org
Independent Living Skills Checklist: Hygiene Updated 09.21.2018
04
# Hygiene Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
10 Use a variety of sinks, showers, and tubs (10th Grade)
11 Brush teeth (2nd Grade)
12 Floss teeth (8th Grade)
13 Use mouthwash (8th Grade)
14 Comb/brush hair (4th Grade)
15 Shampoo own hair (4th Grade)
16 Towel-dry hair (2nd Grade)
17 Dry hair using a hair dryer (6th Grade)
18 Use hair accessories (4th Grade)
19 Use hair styling products or techniques to maintain hairstyle (4th Grade)
20 Identify when a haircut is needed and take steps to get one (10th Grade)
21 Explore hairstyles and communicate desired cut to a hairdresser (10th Grade)
22 Enlist assistance to determine a functional/appropriate hairstyle (10th Grade)
23 Shave legs and underarms (8th Grade)
24 Tweeze own eyebrows (10th Grade)
25 Participate in discussion of hair removal techniques (10th Grade)
26 Use appropriate amounts of cosmetic lotions or creams (10th Grade)
Independent Living Skills Checklist: Hygiene Updated 09.21.2018
05
# Hygiene Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
27 Use appropriate amounts of perfume or cologne (10th Grade)
28 Apply own makeup (8th Grade)
29 Care for own nails (6th Grade)
30 Ensure appropriate grooming and appearance throughout the day (10th Grade)
31 Care for all hygiene needs (12th Grade)
32 Begin discussion about menstrual cycle (4th Grade)
33 Prepare for rst menstrual cycle (6th Grade)
34 Identify when menstrual cycle has begun (8th Grade)
35 Care for own menstrual needs (8th Grade)
36 Participate in purchasing own feminine hygiene products (8th Grade)
37 Know when certain personal hygiene tasks should be performed (8th Grade)
38 Put on a Band-Aid (4th Grade)
39 Clean outer part of ear with cotton swab (4th Grade)
40 Apply deodorant (6th Grade)
41 Clean own eyeglasses (2nd Grade)
42 Care for own eyeglasses (2nd Grade)
43 Clean/care for eye prosthesis (8th Grade)
Independent Living Skills Checklist: Hygiene Updated 09.21.2018
06
Hygiene Skills Checklist Notes
Independent Living Skills Checklist: Hygiene Updated 09.21.2018
07
Independent Living Skills (ILS)
III. Eating Skills Checklist
Student Name:
Date of Birth:
Note: Assessments should take place when students are exiting each grade level.
Assessment Key
I = Independent (no verbal or physical assistance needed)
S = With supervision (independent with monitoring for safety)
VA = Verbal assistance
MA = Minimal assistance (two verbal or physical prompts or fewer)
WA = With assistance (more than two verbal/physical prompts)
CU = Concept understood
# Eating Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
- Date Tasks Assessed
1 Differentiate food from non-food items (Preschool)
2 Identify food on plate (Preschool)
3 Use correct posture at the table (2nd Grade)
4 Use spoon/fork to feed self (Preschool)
5 Use appropriate utensil to feed self (2nd Grade)
6 Chew with mouth closed (Preschool)
7 Use napkin to wipe mouth and hands (Preschool)
8 Take small bites from large food items (Preschool)
9 Demonstrate skills in eating hard to handle or unusual foods (6th Grade)
Low Incidence Outreach
702 W. Kalamazoo St.
Lansing, MI 48915
www.mdelio.org
Independent Living Skills Checklist: Eating Skills Updated 09.21.2018
08
# Eating Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
10 Use bread/utensil as a pusher (2nd Grade)
11 Eat without being messy (2nd Grade)
12 Check for food spills on self (4th Grade)
13 Eat using skills commensurate with mainstream peers (8th Grade)
14 Spread using butter/lettuce knife (2nd Grade)
15 Cut food with side of fork/spoon as appropriate (2nd Grade)
16 Cut food using appropriate utensils (6th Grade)
17 Use spreading and cutting techniques (4th Grade)
18 Cut food using serrated knife (2nd Grade)
19 Peel bananas, oranges, etc. (Preschool)
20 Drink out of cup with no lid (Preschool)
21 Use a straw to sip liquid (Preschool)
22 Use appropriate drinking fountain techniques (2nd Grade)
23 Pour drink (2nd Grade)
24 Locate all items at a simple place setting (Preschool)
25 Locate items in place setting in unfamiliar environments (6th Grade)
26 Pass and serve self from common food dishes (2nd Grade)
Independent Living Skills Checklist: Eating Skills Updated 09.21.2018
09
# Eating Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
27 Identify difference between salt and pepper shakers (2nd Grade)
28 Use salt and pepper shakers (2nd Grade)
29 Use condiments from a variety of containers (2nd Grade)
30 Open a variety of food containers and wrappers (4th Grade)
31 Awareness of different types of vending machines (Preschool)
32 Use vending machines to obtain food/drink (8th Grade)
33 Read a menu and make a selection (8th Grade)
34 Follow all procedures at a variety of fast food restaurants (6th Grade)
35 Use soft drink dispenser at a fast food restaurant (8th Grade)
36 Follow procedures in commercial cafeteria and buffet lines (10th Grade)
37 Utilize salad, entree, and dessert plates in a buffet (10th Grade)
38 Follow procedures at restaurants that have waiters or waitresses (6th Grade)
39 Ask the chef to make food more manageable, as appropriate (8th Grade)
40 Demonstrate knowledge of a healthy diet (6th Grade)
41 Choose a variety of healthy foods such as vegetables, grains, fruits (6th Grade)
Independent Living Skills Checklist: Eating Skills Updated 09.21.2018
10
Eating Skills Checklist Notes
Independent Living Skills Checklist: Eating Skills Updated 09.21.2018
11
Independent Living Skills (ILS)
IV. Cooking Skills Checklist
Student Name:
Date of Birth:
Note: Assessments should take place when students are exiting each grade level.
Assessment Key
I = Independent (no verbal or physical assistance needed)
S = With supervision (independent with monitoring for safety)
VA = Verbal assistance
MA = Minimal assistance (two verbal or physical prompts or fewer)
WA = With assistance (more than two verbal/physical prompts)
CU = Concept understood
# Cooking Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
- Date Tasks Assessed
1 Carry a tray from one location to another (Preschool)
2 Get items from kitchen (Preschool)
3 Return items to correct place after use (Preschool)
4 Wipe up spills (Preschool)
5 Get drink (Preschool)
6 Stir using a variety of utensils/containers (Preschool)
7 Place food in its container and close the container (Preschool)
8 Place food in appropriate locations (2nd Grade)
9 Discuss kitchen safety (2nd Grade)
Low Incidence Outreach
702 W. Kalamazoo St.
Lansing, MI 48915
www.mdelio.org
Independent Living Skills Checklist: Cooking Skills Updated 09.21.2018
12
# Cooking Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
10 Name major appliances (Preschool)
11 Identify functions of major appliances (Preschool)
12 Orient to stove/oven (8th Grade)
13 Discuss safety precautions for major kitchen appliances (2nd Grade)
14 Safely plug/unplug small appliances (2nd Grade)
15 Name small appliances (Preschool)
16 Identify function of small appliances (Preschool)
17 Orient to small appliances (Preschool)
18 Discuss safety procedures for small appliances (4th Grade)
19 Use a variety of small appliances (4th Grade)
20 Utilize all kitchen appliances (4th Grade)
21 Exposure to common cooking utensils (Preschool)
22 Identify/use adaptive kitchen devices (2nd Grade)
23 Use all food preparation utensils appropriately (8th Grade)
24 Use can opener (4th Grade)
25 Use potholders/mitts/trivets when serving hot dishes (10th Grade)
26 Cook using stove/oven (12th Grade)
Independent Living Skills Checklist: Cooking Skills Updated 09.21.2018
13
# Cooking Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
27 Use broiler (12th Grade)
28 Prepare fried/grilled/broiled foods (12th Grade)
29 Plan and prepare food for special occasions/outings (10th Grade)
30 Follow one-to-two-step recipe (10th Grade)
31 Follow three-to-four-step recipe (10th Grade)
32 Develop a recipe le (10th Grade)
33 Cut meat (10th Grade)
34 Cut vegetables (10th Grade)
35 Transfer cold liquids (10th Grade)
36 Transfer hot liquids (10th Grade)
37 Fill serving dishes from pots and pans (10th Grade)
38 Plan meals (10th Grade)
39 Make a grocery list (10th Grade)
40 Follow a grocery list (10th Grade)
41 Shop for items for a planned meal (10th Grade)
42 Compare the quality/quantity/cost of grocery items (10th Grade)
43 Prepare a simple meal (10th Grade)
Independent Living Skills Checklist: Cooking Skills Updated 09.21.2018
14
# Cooking Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
44 Identify categories of a healthy meal, such as protein or vegetables (10th Grade)
45 Discuss healthy versus non-healthy food choices (10th Grade)
46 Plan and prepare a balanced meal from the basic food groups (10th Grade)
47 Discuss identication of spoiled/expired food (2nd Grade)
48 Identify spoiled food (6th Grade)
49 Discuss food safety and sanitation guidelines (6th Grade)
50 Demonstrate kitchen safety/sanitation techniques (6th Grade)
51 Observe expiration dates (8th Grade)
52 Discuss the differences between sell-by and use-by dates (8th Grade)
53 Report shelf life of common foods (8th Grade)
54 Determine the appropriate disposal of food items (8th Grade)
55 Store food appropriately (2nd Grade)
56 Identify/develop methods for organizing kitchen items (10th Grade)
57 Identify/develop methods of organizing and storing food (10th Grade)
58 Label food/drink items (8th Grade)
59 Store and label (as needed) items for a planned meal (10th Grade)
60 Gather necessary items for a snack (2nd Grade)
Independent Living Skills Checklist: Cooking Skills Updated 09.21.2018
15
# Cooking Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
61 Prepare a simple snack (2nd Grade)
62 Use toaster/microwave to make simple snacks (4th Grade)
63 Participate in meal preparation (Preschool)
64 Make a sandwich/lunch (2nd Grade)
65 Pack own lunch (4th Grade)
66 Develop an electronic or paper recipe le (6th Grade)
Cooking Skills Checklist Notes
Independent Living Skills Checklist: Cooking Skills Updated 09.21.2018
16
Independent Living Skills (ILS)
V. Household Chores Checklist
Student Name:
Date of Birth:
Note: Assessments should take place when students are exiting each grade level.
Assessment Key
I = Independent (no verbal or physical assistance needed)
S = With supervision (independent with monitoring for safety)
VA = Verbal assistance
MA = Minimal assistance (two verbal or physical prompts or fewer)
WA = With assistance (more than two verbal/physical prompts)
CU = Concept understood
# Household Chores Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
- Date Tasks Assessed
1 Pick up/put away own toys (Preschool)
2 Straighten items on shelves (Preschool)
3 Demonstrate awareness of where items are stored (Preschool)
4 Perform household chores regularly (2nd Grade)
5 Turn on/off lights (4th Grade)
6 Discuss uses of household cleaning products (2nd Grade)
7 Identify recyclable items (2nd Grade)
8 Regulate the temperature within the home in a safe manner (10th Grade)
9 Use locks/keys (2nd Grade)
Low Incidence Outreach
702 W. Kalamazoo St.
Lansing, MI 48915
www.mdelio.org
Independent Living Skills Checklist: Household Chores Updated 09.21.2018
17
# Household Chores Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
10 Open/close cabinet doors (Preschool)
11 Water plants (2nd Grade)
12 Care for pet(s) (12th Grade)
13 Assist with yard work (8th Grade)
14 Pick up trash and place in trash can (Preschool)
15 Take out trash (4th Grade)
16 Clean own bedroom (12th Grade)
17 Make own bed (4th Grade)
18 Remove sheets/bedding (2nd Grade)
19 Remake bed that has been stripped (4th Grade)
20 Hang towel on hook/rack (Preschool)
21 Clean own bathroom (6th grade)
22 Clean counter/mirrors/windows (8th Grade)
23 Dust/polish furniture (4th Grade)
24 Use broom/dust pan/vacuum to clean oor (6th grade)
25 Mop oors (10th Grade)
26 Clean walls/woodwork (10th Grade)
Independent Living Skills Checklist: Household Chores Updated 09.21.2018
18
# Household Chores Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
27 Place clean silverware in proper place (Preschool)
28 Clear table after meal (Preschool)
29 Scrape own plate into garbage can/disposal (Preschool)
30 Wash/dry/put away dishes (4th Grade)
31 Stack dishes (2nd Grade)
32 Place dishes in dishwasher (Preschool)
33 Load dishwasher, add dish soap, and turn on (4th Grade)
34 Unload dishwasher and put items away (4th Grade)
35 Determine cleanliness of dishes prior to putting away (4th Grade)
36 Set table for family (Preschool)
37 Set formal/informal place settings (10th Grade)
38 Operate household appliances (8th Grade)
39 Clean microwave/small appliances (6th grade)
40 Clean stove and refrigerator on a regular basis (12th Grade)
Independent Living Skills Checklist: Household Chores Updated 09.21.2018
19
Household Chores Checklist Notes
Independent Living Skills Checklist: Household Chores Updated 09.21.2018
20
Independent Living Skills (ILS)
VI. Basic Household Repairs Checklist
Student Name:
Date of Birth:
Note: Assessments should take place when students are exiting each grade level.
Assessment Key
I = Independent (no verbal or physical assistance needed)
S = With supervision (independent with monitoring for safety)
VA = Verbal assistance
MA = Minimal assistance (two verbal or physical prompts or fewer)
WA = With assistance (more than two verbal/physical prompts)
CU = Concept understood
# Basic Household Repairs Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
- Date Tasks Assessed
1 Explore common hand tools (Preschool)
2 Know what common hand tools are used for (2nd Grade)
3 Exposure to common repairs (Preschool)
4 Exposure to home maintenance using simple hand tools (4th Grade)
5 Correctly identify tool needed for repair (12th Grade)
6 Use common hand tools for minor repairs (12th Grade)
7 Perform simple household repairs (10th Grade)
8 Identify when batteries need to be changed (2nd Grade)
9 Identify different types of batteries (2nd Grade)
Low Incidence Outreach
702 W. Kalamazoo St.
Lansing, MI 48915
www.mdelio.org
Independent Living Skills Checklist: Basic Household Repairs Updated 09.21.2018
21
# Basic Household Repairs Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
10 Know battery size for personal items (2nd Grade)
11 Change batteries in a device such as ashlight or smoke detector (4th Grade)
12 Exposure to painting a room or item (6th Grade)
13 Hang items such as pictures or curtains (10th Grade)
Basic Household Repairs Checklist Notes
Independent Living Skills Checklist: Basic Household Repairs Updated 09.21.2018
22
Independent Living Skills (ILS)
VII. Laundry Skills Checklist
Student Name:
Date of Birth:
Note: Assessments should take place when students are exiting each grade level.
Assessment Key
I = Independent (no verbal or physical assistance needed)
S = With supervision (independent with monitoring for safety)
VA = Verbal assistance
MA = Minimal assistance (two verbal or physical prompts or fewer)
WA = With assistance (more than two verbal/physical prompts)
CU = Concept understood
# Laundry Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
- Date Tasks Assessed
1 Put dirty clothes in appropriate place (Preschool)
2 Sort laundry (8th Grade)
3 Check clothes for stains, rips, or missing buttons (6h Grade)
4 Know when clothing is stained (10th Grade)
5 Use appropriate techniques and products to remove stains (10th Grade)
6 Determine size/color of load and select settings (10th Grade)
7 Measure/add laundry detergent (6th Grade)
8 Turn on washer (6th Grade)
9 Remove clothes from washer and place them in dryer (2nd Grade)
Low Incidence Outreach
702 W. Kalamazoo St.
Lansing, MI 48915
www.mdelio.org
Independent Living Skills Checklist: Laundry Skills Updated 09.21.2018
23
# Laundry Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
10 Check lint tray and add fabric softener sheet (6th Grade)
11 Select proper heat/time settings and start dryer (6th Grade)
12 Determine if clothes are dry (6th Grade)
13 Wash/dry clothing, completing all the necessary steps (10th Grade)
14 Hand wash and line dry delicate items (8th Grade)
15 Exposure to common laundry cleaning supplies; discuss safety (2nd Grade)
16 Explain the proper use of common cleaning supplies for clothes (2nd Grade)
17 Demonstrate the safe and proper use of common laundry supplies (10th Grade)
18 Identify when clothes are inside out (Preschool)
19 Fold simple at items (Preschool)
20 Match socks (Preschool)
21 Hang clothes on hangers (Preschool)
22 Put own clothes away (6th Grade)
23 Fold shorts/shirts/pants (2nd Grade)
24 Exposure to coin operated laundry machines (8th Grade)
25 Use coin/card operated laundry (12th Grade)
26 Mend or use alternate methods for repairs (10th Grade)
Independent Living Skills Checklist: Laundry Skills Updated 09.21.2018
24
# Laundry Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
27 Exposure to an iron and alternative wrinkle removing techniques (6th Grade)
28 Search for/download color identication apps for cell phone/tablet (10th Grade)
29 Use color identication apps on cell phone/tablet (10th Grade)
Laundry Skills Checklist Notes
Independent Living Skills Checklist: Laundry Skills Updated 09.21.2018
25
Independent Living Skills (ILS)
VIII. Organizational Skills Checklist
Student Name:
Date of Birth:
Note: Assessments should take place when students are exiting each grade level.
Assessment Key
I = Independent (no verbal or physical assistance needed)
S = With supervision (independent with monitoring for safety)
VA = Verbal assistance
MA = Minimal assistance (two verbal or physical prompts or fewer)
WA = With assistance (more than two verbal/physical prompts)
CU = Concept understood
# Organizational Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
- Date Tasks Assessed
1 Know the correct location of commonly used items (Preschool)
2 Retrieve/return commonly used items (Preschool)
3 Explain the need for keeping items organized (2nd Grade)
4 Assemble materials in a systematic manner (2nd Grade)
5 Explain why things are labeled/marked (Preschool)
6 Use simple labeling system to identify items (2nd Grade)
7 Differentiate between different yet similar items by labeling (2nd Grade)
8 Label/mark personal items (2nd Grade)
9 Use labeling system for personal items (6th Grade)
Low Incidence Outreach
702 W. Kalamazoo St.
Lansing, MI 48915
www.mdelio.org
Independent Living Skills Checklist: Organizational Skills Updated 09.21.2018
26
# Organizational Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
10 Participate in development of tactile/large print marking system (4th Grade)
11 Use tactile/large print marking system (6th Grade)
12 Identify/use most effective labeling system for self (12th Grade)
13 Keep desk organized (4th Grade)
14 Open, place items in, and close backpack (Preschool)
15 Keep backpack organized (4th Grade)
16 Organize school materials (6th Grade)
17 Keep track of school assignments on a daily basis (8th Grade)
18 Complete/turn in assignments on time (8th Grade)
19 Determine daily class materials/needs (8th Grade)
20 Order own educational/leisure materials well in advance (8th Grade)
21 Demonstrate method/techniques for organizing personal space (8th Grade)
22 Organize belongings for next day (10th Grade)
23 Demonstrate organizational skills in daily activities (12th Grade)
24 Clean/organize contents of a tote bag, purse, backpack, or wallet (8th Grade)
25 Organize closets/dressers (10th Grade)
26 Organize clothes for seasonal use (10th Grade)
Independent Living Skills Checklist: Organizational Skills Updated 09.21.2018
27
# Organizational Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
27 Help organize kitchen/bathroom cabinets (6th Grade)
28 Pack suitcase for overnight stay (6th Grade)
29 Pack suitcase for a weekend trip (6th Grade)
30 Pack suitcase for an extended stay (10th Grade)
Organizational Skills Checklist Notes
Independent Living Skills Checklist: Organizational Skills Updated 09.21.2018
28
Independent Living Skills (ILS)
IX. Safety Emergency Procedures Checklist
Student Name:
Date of Birth:
Note: Assessments should take place when students are exiting each grade level.
Assessment Key
I = Independent (no verbal or physical assistance needed)
S = With supervision (independent with monitoring for safety)
VA = Verbal assistance
MA = Minimal assistance (two verbal or physical prompts or fewer)
WA = With assistance (more than two verbal/physical prompts)
CU = Concept understood
# Safety Emergency Procedures Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
- Date Tasks Assessed
1 Know full name, age, birthday (Preschool)
2 Know name(s) of own parent(s) or guardian(s) (Preschool)
3 Describe own parent(s) or guardian(s) (Preschool)
4 Describe Orientation and Mobility instructor or companion(s) (2nd Grade)
5 Prepare emergency plan for being separated from parents in public (4th Grade)
6 Discuss safety personnel roles (2nd Grade)
7 Identify emergency personnel or others who may be helpful (2nd Grade)
8 Discuss community safety procedures (8th Grade)
9 Identify different sirens and know what to do if they sound (2nd Grade)
Low Incidence Outreach
702 W. Kalamazoo St.
Lansing, MI 48915
www.mdelio.org
Independent Living Skills Checklist: Safety Emergency Procedure Updated 09.21.2018
29
# Safety Emergency Procedures Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
10 Discuss purpose of re alarm and carbon monoxide/smoke detector (2nd Grade)
11 Discuss re safety procedures (2nd Grade)
12 Demonstrate “stop-drop-roll” (2nd Grade)
13 Locate entrances/exits in home/classroom (2nd Grade)
14 Exit home when carbon monoxide/smoke detector sounds (2nd Grade)
15 Demonstrate procedures when re alarm/tornado siren sounds (2nd Grade)
16 Use a variety of doors/locks in order to exit in an emergency (2nd Grade)
17 Identify exit(s) to take in home/building in the event of an emergency (2nd Grade)
18 Know how to prevent res (2nd Grade)
19 Know/follow safety procedures for weather emergency (12th Grade)
20 Know appropriate people to call in case of emergencies (12th Grade)
21 Explain what constitutes an emergency (8th Grade)
22 Make a list of telephone numbers to call in an emergency (8th Grade)
23 Identify emergency situations in which injury/illness may occur (6th Grade)
24 Demonstrate actions to take in an emergency (12th Grade)
25 Demonstrate how to use items in a rst aid kit (8th Grade)
26 Demonstrate ability to dial 9-1-1 (Preschool)
Independent Living Skills Checklist: Safety Emergency Procedure Updated 09.21.2018
30
# Safety Emergency Procedures Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
27 Understand dialogue when calling 9-1-1 (2nd Grade)
28 Contact American Red Cross regarding safety seminars (12th Grade)
29 Participate in babysitting class (8th Grade)
30 Demonstrate medical procedures for choking, poisoning, etc. (12th Grade)
31 Demonstrate CPR (12th Grade)
32 Discuss medication/vitamin safety (Preschool)
33 Follow medicine label directions to avoid overdoses/missed doses (12th Grade)
34 Describe/demonstrate/care for people who have common illnesses (12th Grade)
35 Follow safety precautions for electrical outlets (4th Grade)
36 Demonstrate safe practices in using electricity/gas (8th Grade)
37 Safely store and use household chemicals (8th Grade)
38 Follow safety precautions around pools and bodies of water (4th Grade)
39 Know how to prevent, recognize, and respond to water emergencies (12th Grade)
40 Know how to swim (4th Grade)
41 Monitor sun exposure (2nd Grade)
42 Monitor UV Index forecast and apply sunscreen as appropriate (8th Grade)
43 Wear/use appropriate clothing/accessories for sun exposure (4th Grade)
Independent Living Skills Checklist: Safety Emergency Procedure Updated 09.21.2018
31
# Safety Emergency Procedures Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
44 Discuss what to do if a stranger approaches (4th Grade)
45 Determine when to report a crime (10th Grade)
46 Demonstrate skills for reporting a crime (10th Grade)
47 Gain an awareness of internet dangers (8th Grade)
48 Demonstrate safety procedures when surng the internet (10th Grade)
49 Demonstrate safety procedures when searching/downloading apps (12th Grade)
50 Discuss what is safe/unsafe to share on the internet/social media (12th Grade)
51 Discuss what is safe/unsafe to share on the phone/text message (12th Grade)
52 Identify information that should not be shared (e.g., SSN) (12th Grade)
53 Identify nancial information that should not be shared (e.g., PIN) (12th Grade)
Independent Living Skills Checklist: Safety Emergency Procedure Updated 09.21.2018
32
Safety Emergency Procedures Checklist Notes
Independent Living Skills Checklist: Safety Emergency Procedure Updated 09.21.2018
33
Independent Living Skills (ILS)
X. Telephone Skills Checklist
Student Name:
Date of Birth:
Note: Assessments should take place when students are exiting each grade level.
Assessment Key
I = Independent (no verbal or physical assistance needed)
S = With supervision (independent with monitoring for safety)
VA = Verbal assistance
MA = Minimal assistance (two verbal or physical prompts or fewer)
WA = With assistance (more than two verbal/physical prompts)
CU = Concept understood
# Telephone Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
- Date Tasks Assessed
1 Know/identify own telephone number (2nd Grade)
2 Answer phone (Preschool)
3 Converse with familiar person on phone (Preschool)
4 Leave message (2nd Grade)
5 Dial phone to call familiar person (4th Grade)
6 Dial a variety of different phones (2nd Grade)
7 Place long distance call (6th Grade)
8 Know corresponding letters and numbers on a phone keypad (10th Grade)
9 Know when to use alternate non-emergency phone numbers (10th Grade)
Low Incidence Outreach
702 W. Kalamazoo St.
Lansing, MI 48915
www.mdelio.org
Independent Living Skills Checklist: Telephone Skills Updated 7.16.2018
34
# Telephone Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
10 Discuss ways to obtain phone numbers (2nd Grade)
11 Demonstrate ways to obtain phone numbers (4th Grade)
12 Obtain phone numbers using directory assistance (4th Grade)
13 Obtain phone numbers using cell phone voice recognition (4th Grade)
14 Maintain a contact list of emergency numbers (8th Grade)
15 Access numbers from a contact list (8th Grade)
16 Make/use own contact list (4th Grade)
17 Call or order food for take-out or delivery (10th Grade)
18 Program cell phone or use adaptive software (12th Grade)
19 Use cell phone to send/receive text messages (12th Grade)
20 Use VoiceOver/speech recognition assistant such as Siri or Alexa (12th Grade)
21 Search for and download apps (12th Grade)
Independent Living Skills Checklist: Telephone Skills Updated 7.16.2018
35
Telephone Skills Checklist Notes
Independent Living Skills Checklist: Telephone Skills Updated 09.21.2018
36
Independent Living Skills (ILS)
XI. Time Concepts Checklist
Student Name:
Date of Birth:
Note: Assessments should take place when students are exiting each grade level.
Assessment Key
I = Independent (no verbal or physical assistance needed)
S = With supervision (independent with monitoring for safety)
VA = Verbal assistance
MA = Minimal assistance (two verbal or physical prompts or fewer)
WA = With assistance (more than two verbal/physical prompts)
CU = Concept understood
# Time Concepts Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
- Date Tasks Assessed
1 Understand calendar concepts (Preschool)
2 Understand the difference between day and night (Preschool)
3 Demonstrate an understanding of past/future events (Preschool)
4 Demonstrate awareness of the successive order of events (Preschool)
5 Name months of the year (2nd Grade)
6 Differentiate between weekdays/weekends (2nd Grade)
7 Indicate the day of the week when a certain activity happens (4th Grade)
8 Use time words (Preschool)
9 Demonstrate awareness of relative length of time (2nd Grade)
Low Incidence Outreach
702 W. Kalamazoo St.
Lansing, MI 48915
www.mdelio.org
Independent Living Skills Checklist: Time Concepts Updated 09.21.2018
37
# Time Concepts Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
10 Estimate length of time for familiar activities (4th Grade)
11 Relate days/weeks/months to a calendar (2nd Grade)
12 Use calendar or management system to schedule activities (6th Grade)
13 Discuss daily schedule (4th Grade)
14 Explain school schedule (4th Grade)
15 Plan/follow daily schedule (8th Grade)
16 Use variety of schedules (10th Grade)
17 Use calendar for appointment setting (8th Grade)
18 Maintain a calendar of long-range, personally scheduled activities (12th Grade)
19 Demonstrate the concept of being late/early (2nd Grade)
20 Give examples of what to do when late/early (2nd Grade)
21 Set priorities for managing time (8th Grade)
22 Use watch/clock (4th Grade)
23 Tell time to the hour, half hour, quarter hour, minute (8th Grade)
24 Use a variety of clocks (4th Grade)
25 Use alarm clock set by another person (4th Grade)
26 Set/use alarm clock (6th Grade)
Independent Living Skills Checklist: Time Concepts Updated 09.21.2018
38
Time Concepts Checklist Notes
Independent Living Skills Checklist: Time Concepts Updated 09.21.2018
39
Independent Living Skills (ILS)
XII. Money Skills Checklist
Student Name:
Date of Birth:
I = Independent (no verbal or physical assistance needed)
S = With supervision (independent with monitoring for safety)
VA = Verbal assistance
MA = Minimal assistance (two verbal or physical prompts or fewer)
WA = With assistance (more than two verbal/physical prompts)
CU = Concept understood
Note: Assessments should take place when students are exiting each grade level.
Assessment Key
# Money Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
- Date Tasks Assessed
1 Sort/name coins (Preschool)
2 Identify coins by value (2nd Grade)
3 Use techniques to identify paper money (2nd Grade)
4 Organize money in wallet (8th Grade)
5 Carry/store money in a secure manner (2nd Grade)
6 Verify value of bills received from strangers (8th Grade)
7 Understand money is needed to buy things (Preschool)
8 Use money to pay for items (Preschool)
9 Demonstrate awareness that items have different monetary values (2nd Grade)
Low Incidence Outreach
702 W. Kalamazoo St.
Lansing, MI 48915
www.mdelio.org
Independent Living Skills Checklist: Money Skills Updated 09.21.2018
40
# Money Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
10 Discuss taxable/nontaxable items (2nd Grade)
11 Exposure to coin operated machines (Preschool)
12 Make small purchase (2nd Grade)
13 Know if change is due when making a purchase (4th Grade)
14 Give exact amount for purchase (4th Grade)
15 Count change/make sure it is correct (4th Grade)
16 Estimate amount of purchase (4th Grade)
17 Determine if he/she has enough money to make purchase (4th Grade)
18 Estimate total cost of multiple-item purchases (8th Grade)
19 Accompany family to variety of stores (Preschool)
20 Discuss what can be purchased in different stores (Preschool)
21 Identify stores that sell certain items (2nd Grade)
22 Name specic stores where common items can be bought (2nd Grade)
23 Identify attributes wanted in an item (6th Grade)
24 Check for wanted attributes when purchasing item (6th Grade)
25 Return item to store for refund/exchange (6th Grade)
26 Know the difference between refund/store credit (8th Grade)
Independent Living Skills Checklist: Money Skills Updated 09.21.2018
41
# Money Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
27 Use gift card/certicate to make a purchase (6th Grade)
28 Arrange to earn money by performing tasks (6th Grade)
29 Schedule enough chores/jobs to earn a specied amount of money (6th Grade)
30 Manage money at level commensurate with peers (8th Grade)
31 Budget money for weekly expenses (12th Grade)
32 Develop budget for long-range purchase (10th Grade)
33 Explain services provided by banks/credit unions (6th Grade)
34 Use services provided by banks/credit unions (12th Grade)
35 Describe the difference between checking/savings account (8th Grade)
36 Demonstrate how to endorse a check (10th Grade)
37 Write own signature (10th Grade)
38 Monitor checking/savings accounts electronically (12th Grade)
39 Open/manage own bank account(s) (12th Grade)
40 Participate in decisions about the use of own savings account (8th Grade)
41 Explain differences/similarities between credit card/debit card (6th Grade)
42 Use credit/debit card to make purchases (10th Grade)
43 Discuss how to use an ATM (6th Grade)
Independent Living Skills Checklist: Money Skills Updated 09.21.2018
42
# Money Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
44 Use ATM (10th Grade)
45 Awareness of money management software (12th Grade)
46 Search for/download money identication apps on cell phone/tablet (8th Grade)
47 Use money identication apps on cell phone/tablet (8th Grade)
Money Skills Checklist Notes
Independent Living Skills Checklist: Money Skills Updated 09.21.2018
43
Independent Living Skills (ILS)
XIII. Personal Information Checklist
Student Name:
Date of Birth:
Note: Assessments should take place when students are exiting each grade level.
Assessment Key
I = Independent (no verbal or physical assistance needed)
S = With supervision (independent with monitoring for safety)
VA =
Verbal assistance
MA = Minimal assistance (two verbal or physical prompts or fewer)
WA = With assistance (more than two verbal/physical prompts)
CU = Concept understood
# Personal Information Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
- Date Tasks Assessed
1 Know full name, age, birthday (Preschool)
2 Know parents(s)/guardian(s) full name (Preschool)
3 Describe own family (Preschool)
4 Name other family members (Preschool)
5 Name extended family members (2nd Grade)
6 Name friends (Preschool)
7 Provide physical description of parents(s)/guardian(s) (2nd Grade)
8 State full name, age, birthday of parent(s)/guardian(s) and siblings (6th Grade)
9 Know parent(s)/guardian(s) occupation(s) (2nd Grade)
Low Incidence Outreach
702 W. Kalamazoo St.
Lansing, MI 48915
Independent Living Skills Checklist: Personal Information Updated 09.21.2018
www.mdelio.org
44
# Personal Information Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
10 Know complete address (2nd Grade)
11 State where extended family members live (4th Grade)
12 State parent(s)/guardian(s) work/cell phone number(s) (4th Grade)
13 Discuss parent(s)/guardian(s) vehicle type/color (2nd Grade)
14 Describe when it is safe/not safe to share personal information (8th Grade)
15 Describe who it is safe/not safe to share personal information with (8th Grade)
16 Describe personal eye condition (8th Grade)
17 Describe how eye condition impacts daily activities (8th Grade)
18 Explore impact of visual impairment on various careers (10th Grade)
19 Know own social security number (12th Grade)
20 Fill out forms with personal information (12th Grade)
21 Complete a job application correctly (10th Grade)
22 Role play a job interview (10th Grade)
23 Explore various careers (10th Grade)
24 Explore various colleges/universities/vocational schools (10th Grade)
25 Apply for colleges/universities/work study programs (12th Grade)
Independent Living Skills Checklist: Personal Information Updated 09.21.2018
45
# Personal Information Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
26 Apply for nancial aid (12th Grade)
27 Write a resume (10th Grade)
Personal Information Checklist Notes
Independent Living Skills Checklist: Personal Information Updated 09.21.2018
46
Independent Living Skills (ILS)
XIV. Medical Health Care Checklist
Student Name:
Date of Birth:
Note: Assessments should take place when students are exiting each grade level.
Assessment Key
I = Independent (no verbal or physical assistance needed)
S = With supervision (independent with monitoring for safety)
VA = Verbal assistance
MA = Minimal assistance (two verbal or physical prompts or fewer)
WA = With assistance (more than two verbal/physical prompts)
CU = Concept understood
# Medical Health Care Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
- Date Tasks Assessed
1 Describe where a body part hurts (2nd Grade)
2 Describe symptoms of injury/illness to adult (2nd Grade)
3 Actively participate in eye exam (8th Grade)
4 Discuss doctors and type of medical care provided (6th Grade)
5 State name(s) of own doctor(s) (8th Grade)
6 Contact medical practitioner for care (10th Grade)
7 Know personal medical insurance information (12th Grade)
8 Know/state hereditary family health issues (12th Grade)
9 Explore common medical equipment (Preschool)
Low Incidence Outreach
702 W. Kalamazoo St.
Lansing, MI 48915
www.mdelio.org
Independent Living Skills Checklist: Medical Health Care Updated 09.21.2018
47
# Medical Health Care Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
10 Discuss medical care facilities (2nd Grade)
11 Explain why adult supervision is required prior to taking medications (4th Grade)
12 Discuss safety rules associated with medications (6th Grade)
13 Swallow hard tablets/capsules (4th Grade)
14 Identify own medications (12th Grade)
15 Know/state medications used for certain illnesses (4th Grade)
16 Identify locations to purchase/receive medications (4th Grade)
17 Discuss substances that can be harmful for a person's body (6th Grade)
18 Discuss the negative effects of the use of alcohol and drugs (6th Grade)
19 Identify contact(s) for help/questions regarding substance abuse (6th Grade)
20 Demonstrate ways of dealing with peer pressure to use drugs (6th Grade)
21 Aware of positive health habits to maintain a healthy lifestyle/weight (6th Grade)
22 Demonstrate good posture and identify poor posture (4th Grade)
23 Use a scale to determine own weight (6th Grade)
Independent Living Skills Checklist: Medical Health Care Updated 09.21.2018
48
Medical Health Care Checklist Notes
Independent Living Skills Checklist: Medical Health Care Updated 09.21.2018
49
Independent Living Skills (ILS)
XV. Social Skills Checklist
Student Name:
Date of Birth:
Note: Assessments should take place when students are exiting each grade level.
Assessment Key
I = Independent (no verbal or physical assistance needed)
S = With supervision (independent with monitoring for safety)
VA =
MA =
Verbal assistance
Minimal assistance (two verbal or physical prompts or fewer)
WA = With assistance (more than two verbal/physical prompts)
CU = Concept understood
# Social Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
- Date Tasks Assessed
1 Observe/discuss personal space (Preschool)
2 Demonstrate appropriate personal space (Preschool)
3 Discontinue any inappropriate body movements (if applicable) (Preschool)
4 Discontinue any inappropriate self-touching (if applicable) (Preschool)
5 Cover mouth when coughing/sneezing (Preschool)
6 Use please/thank you/excuse me (Preschool)
7 Separate from primary caregiver comfortably (Preschool)
8 Appropriately initiate conversation with adults/peers (Preschool)
9 Discuss ways to compliment others (6th Grade)
Low Incidence Outreach
702 W. Kalamazoo St.
Lansing, MI 48915
www.mdelio.org
Independent Living Skills Checklist: Social Skills Updated 09.21.2018
50
# Social Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
10 Demonstrate ability to take turns/share (2nd Grade)
11 Appropriately ask to see toy, article of clothing, etc. (Preschool)
12 Initiate friendships (2nd Grade)
13 Demonstrate strategies for making friends (2nd Grade)
14 Describe attributes of a good friend (4th Grade)
15 Demonstrate attributes among friends (4th Grade)
16 Identify how different friends can meet different needs (12th Grade)
17 Demonstrate ways to reciprocate with friends (4th Grade)
18 Demonstrate nonverbal communication skills (2nd Grade)
19 Discuss how cultural differences may affect nonverbal cues (10th Grade)
20 Use gestures, as appropriate, during ordinary conversations (8th Grade)
21 Use appropriate facial expressions (8th Grade)
22 Demonstrate socially appropriate conversational skills (Preschool)
23 Use variety of nonverbal behaviors to communicate more effectively (10th Grade)
24 Play board games with peers (2nd Grade)
25 Participate with peers in a variety of games (4th Grade)
26 Participate in school activities (2nd Grade)
Independent Living Skills Checklist: Social Skills Updated 09.21.2018
51
# Social Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
27 Volunteer to work at school events (8th Grade)
28 Participate in community activities (2nd Grade)
29 Participate in extracurricular/community activities (8th Grade)
30 Discuss appropriate behavior in unfamiliar settings (10th Grade)
31 Discuss right/wrong thing to do in different social situations (6th Grade)
32 Discuss ways to deal with peer pressure (6th Grade)
33 Discuss ways to deal with bullying (6th Grade)
34 Understand the benets of following rules/standards of behaviors (10th Grade)
35 Understand consequences of not following standards of behavior (10th Grade)
36 Use assertive techniques in appropriate social situations (12th Grade)
37 Anticipate potential problems and steps to solve them (10th Grade)
38 Research/obtain information regarding personal safety (12th Grade)
39 Discuss the rights/responsibilities of an individual in a relationship (10th Grade)
40 Identify dangers that can occur on dates (10th Grade)
41 Understand what is meant by "date rape" (10th Grade)
42 Understand what to do if attacked/raped on a date (10th Grade)
43 Discuss physical concept of sexual intercourse and contraception (12th Grade)
Independent Living Skills Checklist: Social Skills Updated 09.21.2018
52
# Social Skills Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
44 Discuss conception, pregnancy, labor, birth (12th Grade)
45 Discuss sexually transmitted diseases (12th Grade)
46 Discuss methods of birth control (12th Grade)
Social Skills Checklist Notes
Independent Living Skills Checklist: Social Skills Updated 09.21.2018
53
Independent Living Skills (ILS)
XVI. Self-Advocacy Checklist
Student Name:
Date of Birth:
Assessment Key
I = Independent (no verbal or physical assistance needed)
S = With supervision (independent with monitoring for safety)
VA = Verbal assistance
MA = Minimal assistance (two verbal or physical prompts or fewer)
WA = With assistance (more than two verbal/physical prompts)
CU = Concept understood
Note: Assessments should take place when students are exiting each grade level.
# Self-Advocacy Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
1 Date Tasks Assessed
2 Understand when assistance is needed (2nd Grade)
3 Ask for assistance in familiar settings (Preschool)
4 Request assistance from familiar person (2nd Grade)
5 Ask for assistance when needed (4th Grade)
6 Discuss options for refusing assistance (Preschool)
7 Tactfully refuse assistance when not needed (4th Grade)
8 Reciprocate assistance from volunteers (6th Grade)
9 Express appreciation for assistance (2nd Grade)
10 Ask for accommodations (4th Grade)
Low Incidence Outreach
702 W. Kalamazoo St.
Lansing, MI 48915
www.mdelio.org
Independent Living Skills Checklist: Self Advocacy Updated 09.21.2018
54
# Self-Advocacy Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
11 Phrase requests as a question (Preschool)
12 Inform others of own special needs in a variety of situations (6th Grade)
13 Describe environmental modications to increase independence (6th Grade)
14 Determine how materials can be adapted (6th Grade)
15 Inform others of needs in a variety of situations (6th Grade)
16 Use “excuse me” to interrupt others (Preschool)
17 Discuss appropriate expectations (2nd Grade)
18 Handle/report/bullying (2nd Grade)
19 Appropriately ask for clarication when seeking information (8th Grade)
20 Demonstrate assertiveness without being aggressive in conversations (8th Grade)
21 Discuss how personal decisions are based on own set of values (8th Grade)
22 Demonstrate basic understanding of own etiology/visual abilities (4th Grade)
23 Demonstrate an understanding of own etiology and visual abilities (8th Grade)
24 Describe activities that are difcult due to visual impairment (4th Grade)
25 Provide information regarding persons who are BVI (6th Grade)
26 Take responsibility for own success in school (4th Grade)
27 Discuss available resources (2nd Grade)
Independent Living Skills Checklist: Self Advocacy Updated 09.21.2018
55
# Self-Advocacy Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
28 Express personal preferences for reading media/aids (8th grade)
29 Receive/return books (8th Grade)
30 Demonstrate knowledge of agencies that provide adapted resources (8th Grade)
31 Contact/arrange for braille/large print texts for one subject area (8th Grade)
32 Explore ways to locate a reader (10th Grade)
33 Use reader(s) (10th Grade)
34 Demonstrate technological skills to access print materials (8th Grade)
35 Use/care for complex adaptive devices (6th Grade)
36 Inform appropriate person of needed technology repairs (10th Grade)
37 Contact agencies/companies that sell adaptive technology (10th Grade)
38 Know where various adapted materials/equipment are purchased (6th Grade)
39 Participate in purchasing various adapted materials/equipment (6th Grade)
40 Contact adaptive technology companies for repairs (10th Grade)
41 Explain the purpose of related services that are being received (6th Grade)
42 Contact organizations that provide services to persons who are BVI (10th Grade)
43 Participate in own individualized education program (IEP) (8th Grade)
Independent Living Skills Checklist: Self Advocacy Updated 09.21.2018
56
Self-Advocacy Checklist Notes
Independent Living Skills Checklist: Self Advocacy Updated 09.21.2018
57
Independent Living Skills (ILS)
XVII. Orientation and Mobility (O&M) Checklist
Student Name:
Date of Birth:
Note: Assessments should take place when students are exiting each grade level.
Assessment Key
I = Independent (no verbal or physical assistance needed)
S = With supervision (independent with monitoring for safety)
VA = Verbal assistance
MA = Minimal assistance (two verbal or physical prompts or fewer)
WA = With assistance (more than two verbal/physical prompts)
CU = Concept understood
# Orientation and Mobility Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
- Date Tasks Assessed
1 Localize sound (Preschool)
2 Move toward sound source (Preschool)
3 Identify familiar environmental sounds (Preschool)
4 Use environmental sounds as clues when traveling (2nd Grade)
5 Awareness of environmental clues/landmarks (Preschool)
6 Follow simple verbal directions (2nd Grade)
7 Follow one-step commands (Preschool)
8 Identify own body parts (Preschool)
9 Locate dropped object (Preschool)
Low Incidence Outreach
702 W. Kalamazoo St.
Lansing, MI 48915
www.mdelio.org
Independent Living Skills Checklist: Orientation and Mobility Updated 09.21.2018
58
# Orientation and Mobility Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
10 Hold object while walking (Preschool)
11 Travel in a group (Preschool)
12 Push chair under table (Preschool)
13 Demonstrate directional concepts (up, down, under, below, etc.) (Preschool)
14 Know right/left directional concepts (2nd Grade)
15 Demonstrate an understanding of cardinal directions (4th Grade)
16 Use cardinal directions (8th Grade)
17 Use basic safety/protective techniques (Preschool)
18 Use trailing skills (2nd Grade)
19 Use squaring off technique (2nd Grade)
20 Use appropriate gait when walking (Preschool)
21 Walk up/down stairs safely (Preschool)
22 Walk up/down stairs using alternating feet (2nd Grade)
23 Exposure to signage (Preschool)
24 Correctly identify signage on doors/buildings (2nd Grade)
25 Locate own classroom from entrance of school building (2nd Grade)
26 Travel to classes in school (2nd Grade)
Independent Living Skills Checklist: Orientation and Mobility Updated 09.21.2018
59
# Orientation and Mobility Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
27 Navigate school lunch line (2nd Grade)
28 Travel to locations in familiar environments (Preschool)
29 Know location of important places (4th Grade)
30 Enter/exit car, bus, etc. (2nd Grade)
31 Engage/disengage own seatbelt (Preschool)
32 Safely open/close vehicle door (2nd Grade)
33 Exposure to public transportation (6th Grade)
34 Use public transportation (12th Grade)
35 Identify differences between landmarks/clues (4th Grade)
36 Use landmarks/clues (8th Grade)
37 Begin pairing cardinal directions to other landmarks (8th Grade)
38 Follow multi-step directions (6th Grade)
39 Ask for directions (6th Grade)
40 Restate/clarify directions (6th Grade)
41 Follow directions (6th Grade)
42 Discuss directions to home from school, friend's home, etc. (4th Grade)
43 Give directions home from familiar places (6th Grade)
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# Orientation and Mobility Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
44 Give directions to/from place of choice (8th Grade)
45 Use sighted guide appropriately (2nd Grade)
46 Appropriately accept/refuse assistance (2nd Grade)
47 Give appropriate instruction for sighted guide technique (8th Grade)
48 Use adaptive mobility device (Preschool)
49 Identify own cane (2nd Grade)
50 Identify/name parts of cane (2nd Grade)
51 Know/use appropriate place to store cane in classroom, home, etc. (2nd Grade)
52 Use basic cane techniques (2nd Grade)
53 Use appropriate cane technique for environment/situation (4th Grade)
54 Introduction to electronic aids (8th Grade)
55 Introduction to guide dogs (10th Grade)
56 Introduction to optical aids (8th Grade)
57 Use monocular (6th Grade)
58 Use low vision aides (6th Grade)
59 Use/care for optical/electronic aids, etc. (12th Grade)
60 Begin creating mental maps (2nd Grade)
Independent Living Skills Checklist: Orientation and Mobility Updated 09.21.2018
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# Orientation and Mobility Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
61 Demonstrate the use of mental maps (4th Grade)
62 Exposure to tactile/large print maps (4th Grade)
63 Use tactile/large print maps (6th Grade)
64 Use maps of familiar locations (6th Grade)
65 Identify street names/landmarks along commonly traveled routes (2nd Grade)
66 Name major cross streets near home (4th Grade)
67 Determine appropriate time to cross street in residential area (2nd Grade)
68 Cross residential street (4th Grade)
69 Identify different types of curbs (2nd Grade)
70 Discuss/exposure to trafc patterns (4th Grade)
71 Exposure to parallel/perpendicular trafc movement (2nd Grade)
72 Identify parallel/perpendicular trafc (4th Grade)
73 Cross street using parallel/perpendicular trafc (8th Grade)
74 Discuss/exposure to different intersections (4th Grade)
75 Identify various intersections (8th Grade)
76 Exposure to intersections with signal lights (4th Grade)
77 Determine when to cross complex intersections with signal lights (8th Grade)
Independent Living Skills Checklist: Orientation and Mobility Updated 09.21.2018
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# Orientation and Mobility Task (Optimal time a student could complete the task) Preschool 2nd Grade 4th Grade 6th Grade 8th Grade 10th Grade 12th Grade
78 Cross intersections with signal lights (6th Grade)
79 Describe familiar small business area (8th Grade)
80 Make necessary arrangements/preparations to go shopping (10th Grade)
81 Know the hours and days of operation for local businesses (10th Grade)
82 Determine location of service desk (10th Grade)
83 Identify location of items in store(s) (4th Grade)
84 Solicit assistance to gather additional information about a product (8th Grade)
85 Demonstrate use of escalators, elevators etc. (8th Grade)
86 Demonstrate use of sliding doors, revolving doors, etc. (8th Grade)
87 Incorporate all acquired O&M skills for travel in familiar areas (6th Grade)
88 Incorporate all acquired O&M skills for travel in unfamiliar areas (8th Grade)
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Orientation and Mobility Notes
Independent Living Skills Checklist: Orientation and Mobility Updated 09.21.2018
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Independent Living Skills (ILS) Checklist

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Completed 29 March 2022

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