A complete sample packet.

My daily job checklist

My schedule: Monday, Wednesday, Friday · 9–11 a.m.

Today’s date: ____________________

My work today

• Check in with the shift supervisor.
• Collect the supplies for the assigned task.
• Bag groceries using the method demonstrated by the supervisor.
• Stock items in the assigned area.
• Return supplies to their labeled places.
• Tell the supervisor when the work is finished.

Before I leave

I check with my supervisor that my work is finished.

My check-in

One thing I did well: __________________________________

Something I want help with: ____________________________

A check means the task is finished. It does not show how much help I used.

Job-coach guide

Support participation. Notice what the learner does independently.

Focus for this placement

Build independence with daily tasks and communicate when help or another task is needed.

Use the learner’s preferred supports

Offer a written or picture checklist. Demonstrate unfamiliar tasks. Allow processing time before repeating an instruction. Accept spoken words, gestures, or the learner’s preferred communication tool.

Teach → pause → observe

• Confirm the task and ask how the learner wants instructions presented.
• For a new task, model the site-approved steps and check understanding.
• Allow the agreed processing time. Offer the least intrusive effective support within the learner’s support plan.
• After success, reduce unnecessary prompting when the learner is ready. Keep access tools and agreed accommodations available.
• Record the support actually used. Ask the learner what helped.

Tasks to observe

1. Check in with the shift supervisor.
2. Collect the supplies for the assigned task.
3. Bag groceries using the method demonstrated by the supervisor.
4. Stock items in the assigned area.
5. Return supplies to their labeled places.
6. Tell the supervisor when the work is finished.

Progress measure

Across five observed shifts, begin the next assigned task with no more than one verbal reminder in at least four shifts. Record requests for help separately.

Record separately: independent starts, help requests, and the prompt or direct support used. Do not count an unobserved task as unsuccessful.

Safety check

The supervisor must confirm lifting limits, approved stock areas, and emergency procedures before the placement begins. Pause and ask before handling unfamiliar equipment.

Support fading should be planned with the learner and team. Do not withhold a needed accommodation to test independence.

Employer quick guide

Clear expectations for a welcoming work experience.

Day-to-day help contact: Shift supervisor

Work the learner is practicing

1. Check in with the shift supervisor.
2. Collect the supplies for the assigned task.
3. Bag groceries using the method demonstrated by the supervisor.
4. Stock items in the assigned area.
5. Return supplies to their labeled places.
6. Tell the supervisor when the work is finished.

Learning focus

Build independence with daily tasks and communicate when help or another task is needed.

Helpful ways to communicate and teach

Offer a written or picture checklist. Demonstrate unfamiliar tasks. Allow processing time before repeating an instruction. Accept spoken words, gestures, or the learner’s preferred communication tool.

A useful workplace routine

• At arrival: confirm the assigned task and where to begin.
• During work: give clear, respectful feedback about an observable action. Ask the learner before stepping in.
• When work is finished: confirm the result and identify the next task.
• At departure: share one success and any support or safety issue with the program contact.

Confirm before work begins

The supervisor must confirm lifting limits, approved stock areas, and emergency procedures before the placement begins. Pause and ask before handling unfamiliar equipment.

Program contact / preferred method: __________________________________
Agreed feedback date: __________________________________

Workplace evaluation

Describe what happened, with a specific example.

Observer: ____________________   Observation date(s): ______________

Learning goal

Build independence with daily tasks and communicate when help or another task is needed.

Choose one code per row: I = Independent within the agreed support plan · P = Prompt / reminder · S = Direct assistance · N = Not observed. Agreed accommodations remain available for all codes. These codes are descriptions, not a numeric score.

What is working well?

____________________________________________________________________
____________________________________________________________________

What is a useful next step?

____________________________________________________________________
____________________________________________________________________

The learner’s perspective

“What went well? What support would you like?”

____________________________________________________________________

Discuss the observation with the learner and team. Do not infer ability from a skill that was not observed.

Progress-data sheet

One review window. Observations that support the next decision.

Week / dates: ____________________   Observer: ____________________

Measure being tracked

Across five observed shifts, begin the next assigned task with no more than one verbal reminder in at least four shifts. Record requests for help separately.

Task codes: I = Independent within the agreed support plan · P = Prompt / reminder · S = Direct assistance · N = Not observed. Leave unused future shifts blank. Label shift dates below.

Attendance and time record

For a worked shift: (end − start − unpaid break) ÷ 60 = hours when using minutes. Check time entries; use the employer’s required payroll record for paid work.

Evidence / learner feedback / next adjustment

____________________________________________________________________
____________________________________________________________________

Note task starts and communication separately when required by the goal. Keep N (not observed) separate from observed performance.