Family Information

Child's Name: Parent/Caregiver: Date:

Daily Routine Skill Development

Morning Routine

Skill Current Support Needed Goal Progress Notes
Getting Dressed ☐ Full Support ☐ Partial Support ☐ Independent
Personal Hygiene ☐ Full Support ☐ Partial Support ☐ Independent
Breakfast Preparation ☐ Full Support ☐ Partial Support ☐ Independent

Daily Living Skills

Skill Current Support Needed Goal Progress Notes
Cleaning Up Toys ☐ Full Support ☐ Partial Support ☐ Independent
Helping with Chores ☐ Full Support ☐ Partial Support ☐ Independent
Following Simple Instructions ☐ Full Support ☐ Partial Support ☐ Independent

Evening Routine

Skill Current Support Needed Goal Progress Notes
Bedtime Preparation ☐ Full Support ☐ Partial Support ☐ Independent
Personal Care ☐ Full Support ☐ Partial Support ☐ Independent
Winding Down ☐ Full Support ☐ Partial Support ☐ Independent

Weekly Skill Focus

Focus Skills for This Week:

Support Strategies

Successful Strategies This Week:

Challenges Encountered: