DLC Warren

Applying Deodorant – Task Analysis

Student Response: Student will apply deodorant to both underarms to increase independence with hygiene and cleanliness

STEPS

1. Gets deodorant

2. Removes cap

3. Lifts up shirt (or removes

shirt)

4. Applies deodorant under

right arm with 3 strokes

5. Applies deodorant under

left arm with 3 strokes

6. Replaces cap on deodorant

7. Puts deodorant away

8. Adjusts shirt (pulls down)

or dons shirt

Teacher/Therapist Name: Megan Perez

Program: Age- Appropriate Leisure

Direction : Play a board game

Student Response: Student will participate to play a board game with a family member(s) to practice turn taking, waiting

skills, social skills etc..

Date

Comments:

Program: Age-Appropriate Leisure

Direction : Expressive art

Student Response: Student will participate to color, draw or create using art supplies of their choosing

Date

Comments:

DLC Warren

Picking Up Laundry – Task Analysis

Student Response: Student will pick up laundry to increase independence with

home management skills

STEPS

Gets laundry basket and

brings to area with laundry

Picks up clothing and

places in basket

Picks up clothing and places

in basket

Picks up clothing and

places in basket

Picks up clothing and

places in basket

Picks up clothing and places

in basket

Picks up basket and brings

to laundry room

Total

Note: This data is not graphed. Once this sheet is complete, file it in the binder. COMMENTS:

Occupational Therapy Vocational Education

TASK ANALYSIS - DATA FORM

Worker: IEP Goal:

Objective:

Class:

Task: Folding Towels

SD: "Fold the towels"

I = Independent

G = Gestural Prompt

P = Physical Prompt

Developmental Learning Center Warren

Note: This data is not graphed. Once this sheet is complete, file it in the binder.

COMMENTS:

ND = Not Done

Date Date Date Date Date Date Date Date Date Date

Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff

STEPS

Places towel, opened, on table

Folds towel in half ends meetin

Folds towel in half again (ends meeting)

Places towel in pile (maintaining neatness)

TASK ANALYSIS

STUDENT:

TASK: Clearing Table

SD:

Clear the table

*** 1 place setting

IEP Goal:

Class:

Independent G=

Gestural Prompt P=

Physical Prompt

Prom t non-verball from behind

DATE DATE DATE DATE DATE DATE DATE OATE DATE DATE

STEPS

STAFF STAFF STAFF STAFF STAFF STAFF STAFF STAFF STAF F

STAFF

Get the bin

Walk to the table

Put the cup in the bin

Put the plate in the bin

Put the silverware in the bin

Walk to sink

Place bin on counter

Take out cup & put in sink

Take out plate & put in sink

Take out silverware & put in

Occupational Therapy Domestic Tasks TASK ANALYSIS - DATA FORM

Student: IEP Goal:

Objective:

Class:

Developmental Lear

Note: This data is not

graphed. Once this sheet

is complete, file it in the

binder.

COMMENTS:

Date Date Date Date Date Date Date Date Date Date

Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff

SD "Set the table"

I = Independent

G = Gestural Prompt

V = Verbal Prompt

P = Physical Prompt

ND = Not Done

STEPS

Places plate in middle of placemat

Places fork to left of plate

Places spoon to right of plate

Places knife to right of plate

Places cup at top of placemat

Developmental Learning Warren

Note: This data is not graphed. Once this sheet is complete, file it in the binder.

COMMENTS:

Occupational Therapy Vocational Education

TASK ANALYSIS - DATA FORM

Worker: IEP Goal:

Objective:

Class:

Developmental Learning Center Warren

Note: This data is not graphed. Once this sheet is complete, file it in the

binder.

COMMENTS:

Date Date Date Date Date Date Date Date Date Date

Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff

STEPS

Get the broom

Get the dustpan

Walk to area to be swe t

Sweep the pile into the dustpan

Put the broom down

Carry the dustpan to the garbage bin

Dump debris into the garba e bin

Put items away

Developmental Learning Warren

Note: This data is not graphed. Once this sheet is complete, file it in the

binder.

COMMENTS:

Task: Sweeping

SD: "sweep the floor"

I = Independent

G = Gestural Prompt

V Verbal Prompt

P = Physical Prompt

ND = Not Done

Developmental Learning Center Warren

Note: This data is not graphed. Once this sheet is complete, file it in the

binder.

COMMENTS:

Center

Occupational Therapy Domestic Tasks TASK ANALYSIS - DATA FORM

Student: IEP Goal: Objective:

Class:

SD "Hang the clothes"

I = Independent

G = Gestural Prompt

V = Verbal Prompt

P = Physical Prompt

ND = Not Done

Date Date Date Date Date Date Date Date Date Date

Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff

STEPS

Obtains shirt hanger

Places one end of hanger in top of shirt

Places opposite end of hanger in top of shirt

Straightens shirt on hanger

Developmental Learning Warren

Note: This data is not graphed. Once this sheet is complete, file it in the

binder.

COMMENTS:

Hangs shirt in closet

Vocational Education

TASK ANALYSIS - DATA FORM

Student: IEP Goal:

Objective:

Class:

Date Staff Job

m p t S

Job o m

ion Job p

m p

s

Fini Comments

Developmental Learning Center Warren

Note: This data is not graphed. Once this sheet is complete, file it in the

binder.

COMMENTS:

Task: Completing chore list

SD:

I = Independent

G = Gestural Prompt

P = Physical Prompt

ND = Not Done

Developmental Learning Center Warren

Occupational Therapy Vocational Education

TASK ANALYSIS - DATA FORM Worker: IEP Goal:

Objective:

Class:

Task: Clean the Table

SD: "wash the table"

I = Independent G =

Gestural Prompt

P = Physical Prompt

ND = Not Done

Date Date Date Date Date Date Date Date Date Date

Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff

STEPS

Get the spray bottle

Get the paper towels

Walk to the table

Spray the table

Wipe the entire area

Note: This data is not graphed. Once this sheet is complete, file it in the binder. CONflVIENTS:

Developmental Learning Center Warren

Vocational Education

TASK ANALYSIS - DATA

FORM

Student: IEP Goal:

Objective:

Class:

Task: Stocking Shelves (5 items)

SD:

I = Independent

G = Gestural Prompt

P = Physical Prompt

ND = Not Done

Date Date Date Date Date Date Date Date Date Date

Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff

STEPS

Picks up item from table

Places on correct shelf

Picks up item from table

Places on correct shelf

Picks up item from table

Places on correct shelf

Picks up item from table

Places on correct shelf

Picks up item from table

Places on correct shelf

Note: This data is not graphed. Once this sheet is complete, file it in the binder. COMMENTS:

Occupational Therapy Domestic Tasks

Developmental Learning Center Warren

TASK ANALYSIS - DATA FORM Worker:

Class:

Goal: Objective:

Task: IR ED

SD: "make the bed"

I = Independent

G = Gestural Prompt

V = Verbal Prompt P

= Physical Prompt

ND = Not Done

Date Date Date Date Date Date Date Date Date

Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff

STEPS

Walk to the bed

Pull up flat sheet

Straighten flat sheet

Pull up comforter

Straighten comforter

Place pillow at top of bed

Place pillow with sham at top of bed

Developmental Learning Center Warren

Note: This data is not graphed. Once this sheet is complete, file it in the

binder.

COMMENTS:

Occupational Therapy Domestic Tasks

TASK ANALYSIS - DATA FORM

Worker: IEP Goal:

Objective:

Class:

Task: Putting Away Dishes

SD: "Put the dishes

away"

I = Independent

G = Gestural Prompt

P = Physical Prompt

V= Verbal Prompt

ND = Not Done

Date Date Date Date Date Date Date Date Date

Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff

STEPS

Walk to the sink

Get the dish from the drying rack

Walk to the appropriate cabinet

Developmenta

l Learning Cente

r Warren

Place the dish in the cabinet

Close the cabinet door

Note: This data is not graphed. Once this sheet is complete, file it in the binder.

DLC Warren

Vacuum – Task Analysis Student Response: Student will vacuum an entire surface area for all steps

STEPS

1. Bring vacuum to rug area

2.Unwinds cord

3. Plugs cord with assist

4. Turns switch to ON

5. Releases foot lever

6.Vacuums area with thoroughness

7. Turns vacuum off

8. Unplugs and winds cord

9. Puts vacuum away

DLC Warren

Applying Deodorant – Task Analysis

Student Response: Student will apply deodorant to both underarms to increase independence with hygiene and cleanliness

STEPS

1. Gets deodorant

2. Removes cap

3. Lifts up shirt (or removes

shirt)

4. Applies deodorant under

right arm with 3 strokes

5. Applies deodorant under

left arm with 3 strokes

6. Replaces cap on deodorant

7. Puts deodorant away

8. Adjusts shirt (pulls down)

or dons shirt

Teacher/Therapist Name: Megan Perez

Program: Age- Appropriate Leisure

Direction : Play a board game

Student Response: Student will participate to play a board game with a family member(s) to practice turn taking, waiting

skills, social skills etc..

Date

Comments:

Program: Age-Appropriate Leisure

Direction : Expressive art

Student Response: Student will participate to color, draw or create using art supplies of their choosing

Date

Comments:

DLC Warren

Picking Up Laundry – Task Analysis

Student Response: Student will pick up laundry to increase independence with

home management skills

STEPS

Gets laundry basket and

brings to area with laundry

Picks up clothing and

places in basket

Picks up clothing and places

in basket

Picks up clothing and

places in basket

Picks up clothing and

places in basket

Picks up clothing and places

in basket

Picks up basket and brings

to laundry room

Total

Note: This data is not graphed. Once this sheet is complete, file it in the binder. COMMENTS:

Occupational Therapy Vocational Education

TASK ANALYSIS - DATA FORM

Worker: IEP Goal:

Objective:

Class:

Task: Folding Towels

SD: "Fold the towels"

I = Independent

G = Gestural Prompt

P = Physical Prompt

Developmental Learning Center Warren

Note: This data is not graphed. Once this sheet is complete, file it in the binder.

COMMENTS:

ND = Not Done

Date Date Date Date Date Date Date Date Date Date

Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff

STEPS

Places towel, opened, on table

Folds towel in half ends meetin

Folds towel in half again (ends meeting)

Places towel in pile (maintaining neatness)

TASK ANALYSIS

STUDENT:

TASK: Clearing Table

SD:

Clear the table

*** 1 place setting

IEP Goal:

Class:

Independent G=

Gestural Prompt P=

Physical Prompt

Prom t non-verball from behind

DATE DATE DATE DATE DATE DATE DATE OATE DATE DATE

STEPS

STAFF STAFF STAFF STAFF STAFF STAFF STAFF STAFF STAF F

STAFF

Get the bin

Walk to the table

Put the cup in the bin

Put the plate in the bin

Put the silverware in the bin

Walk to sink

Place bin on counter

Take out cup & put in sink

Take out plate & put in sink

Take out silverware & put in

Occupational Therapy Domestic Tasks TASK ANALYSIS - DATA FORM

Student: IEP Goal:

Objective:

Class:

Developmental Lear

Note: This data is not

graphed. Once this sheet

is complete, file it in the

binder.

COMMENTS:

Date Date Date Date Date Date Date Date Date Date

Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff

SD "Set the table"

I = Independent

G = Gestural Prompt

V = Verbal Prompt

P = Physical Prompt

ND = Not Done

STEPS

Places plate in middle of placemat

Places fork to left of plate

Places spoon to right of plate

Places knife to right of plate

Places cup at top of placemat

Developmental Learning Warren

Note: This data is not graphed. Once this sheet is complete, file it in the binder.

COMMENTS:

Occupational Therapy Vocational Education

TASK ANALYSIS - DATA FORM

Worker: IEP Goal:

Objective:

Class:

Developmental Learning Center Warren

Note: This data is not graphed. Once this sheet is complete, file it in the

binder.

COMMENTS:

Date Date Date Date Date Date Date Date Date Date

Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff

STEPS

Get the broom

Get the dustpan

Walk to area to be swe t

Sweep the pile into the dustpan

Put the broom down

Carry the dustpan to the garbage bin

Dump debris into the garba e bin

Put items away

Developmental Learning Warren

Note: This data is not graphed. Once this sheet is complete, file it in the

binder.

COMMENTS:

Task: Sweeping

SD: "sweep the floor"

I = Independent

G = Gestural Prompt

V Verbal Prompt

P = Physical Prompt

ND = Not Done

Developmental Learning Center Warren

Note: This data is not graphed. Once this sheet is complete, file it in the

binder.

COMMENTS:

Center

Occupational Therapy Domestic Tasks TASK ANALYSIS - DATA FORM

Student: IEP Goal: Objective:

Class:

SD "Hang the clothes"

I = Independent

G = Gestural Prompt

V = Verbal Prompt

P = Physical Prompt

ND = Not Done

Date Date Date Date Date Date Date Date Date Date

Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff

STEPS

Obtains shirt hanger

Places one end of hanger in top of shirt

Places opposite end of hanger in top of shirt

Straightens shirt on hanger

Developmental Learning Warren

Note: This data is not graphed. Once this sheet is complete, file it in the

binder.

COMMENTS:

Hangs shirt in closet

Vocational Education

TASK ANALYSIS - DATA FORM

Student: IEP Goal:

Objective:

Class:

Date Staff Job

m p t S

Job o m

ion Job p

m p

s

Fini Comments

Developmental Learning Center Warren

Note: This data is not graphed. Once this sheet is complete, file it in the

binder.

COMMENTS:

Task: Completing chore list

SD:

I = Independent

G = Gestural Prompt

P = Physical Prompt

ND = Not Done

Developmental Learning Center Warren

Occupational Therapy Vocational Education

TASK ANALYSIS - DATA FORM Worker: IEP Goal:

Objective:

Class:

Task: Clean the Table

SD: "wash the table"

I = Independent G =

Gestural Prompt

P = Physical Prompt

ND = Not Done

Date Date Date Date Date Date Date Date Date Date

Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff

STEPS

Get the spray bottle

Get the paper towels

Walk to the table

Spray the table

Wipe the entire area

Note: This data is not graphed. Once this sheet is complete, file it in the binder. CONflVIENTS:

Developmental Learning Center Warren

Vocational Education

TASK ANALYSIS - DATA

FORM

Student: IEP Goal:

Objective:

Class:

Task: Stocking Shelves (5 items)

SD:

I = Independent

G = Gestural Prompt

P = Physical Prompt

ND = Not Done

Date Date Date Date Date Date Date Date Date Date

Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff

STEPS

Picks up item from table

Places on correct shelf

Picks up item from table

Places on correct shelf

Picks up item from table

Places on correct shelf

Picks up item from table

Places on correct shelf

Picks up item from table

Places on correct shelf

Note: This data is not graphed. Once this sheet is complete, file it in the binder. COMMENTS:

Occupational Therapy Domestic Tasks

Developmental Learning Center Warren

TASK ANALYSIS - DATA FORM Worker:

Class:

Goal: Objective:

Task: IR ED

SD: "make the bed"

I = Independent

G = Gestural Prompt

V = Verbal Prompt P

= Physical Prompt

ND = Not Done

Date Date Date Date Date Date Date Date Date

Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff

STEPS

Walk to the bed

Pull up flat sheet

Straighten flat sheet

Pull up comforter

Straighten comforter

Place pillow at top of bed

Place pillow with sham at top of bed

Developmental Learning Center Warren

Note: This data is not graphed. Once this sheet is complete, file it in the

binder.

COMMENTS:

Occupational Therapy Domestic Tasks

TASK ANALYSIS - DATA FORM

Worker: IEP Goal:

Objective:

Class:

Task: Putting Away Dishes

SD: "Put the dishes

away"

I = Independent

G = Gestural Prompt

P = Physical Prompt

V= Verbal Prompt

ND = Not Done

Date Date Date Date Date Date Date Date Date

Staff Staff Staff Staff Staff Staff Staff Staff Staff Staff

STEPS

Walk to the sink

Get the dish from the drying rack

Walk to the appropriate cabinet

Developmenta

l Learning Cente

r Warren

Place the dish in the cabinet

Close the cabinet door

Note: This data is not graphed. Once this sheet is complete, file it in the binder.

DLC Warren

Vacuum – Task Analysis Student Response: Student will vacuum an entire surface area for all steps

STEPS

1. Bring vacuum to rug area

2.Unwinds cord

3. Plugs cord with assist

4. Turns switch to ON

5. Releases foot lever

6.Vacuums area with thoroughness

7. Turns vacuum off

8. Unplugs and winds cord

9. Puts vacuum away