54+3

Learner: ____________________ Assessment of Functional Living Skills

Assessor Date Color Code Skills Tracking System
Independent Living Skills

SC 37
SC 36 MC 36 TR 37
SC 35 MC 35 TR 36
SC 34 MC 34 TR 35
SC 33 MC 33 TR 34
SC 32 MC 32 TR 33
SC 31 TR 32
SC 30 MC 31 TR 31
MC 30 TR 30
SC 29 MC 29 TR 29
SC 28 MC 28 TR 28
SC 27 MC 27 TR 27
SC 26 MC 26 TR 26
SC 25 MC 25 CT 26 TR 25
SC 24 CT 25
OS 23 SC 23 MC 24 CT 24 TR 24
OS 22 SC 22 MC 23 CT 23 TR 23
OS 21 SC 21 MC 22 CT 22 TR 22 KA 23
OS 20 MC 21 TR 21 KA 22
SC 20 MC 20 MR 21 CT 21 TR 20 KA 21
OS 19 SC 19 MC 19 MR 20 CT 20 TR 19 KA 20 FM 19
OS 18 SC 18 MC 18 MR 19 CT 19 TR 18 KA 19 FM 18
OS 17 SC 17 MR 18 CT 18 TR 17 KA 18 FM 17
OS 16 SC 16 MC 17 MR 17 CT 17 TR 16 KA 17 FM 16
OS 15 SC 15 MC 16 MR 16 CT 16 TR 15 KA 16 FM 15
SC 14 MC 15 MR 15 CT 15 KA 15
OS 14 SC 13 MR 14 CT 14 TR 14 KA 14 FM 14
OS 13 SC 12 MC 14 MR 13 TR 13 KA 13 FM 13
OS 12 MC 13 MR 12 CT 13 TR 12 KA 12 FM 12
OS 11 SC 11 MC 12 MR 11 CT 12 TR 11 KA 11 FM 11
OS 10 SC 10 MC 11 CT 11 TR 10 KA 10 FM 10
OS 9 SC 9 MC 10 MR 10 CT 10 FM 9
OS 8 SC 8 MC 9 MR 9 CT 9 TR 9 KA 9
OS 7 SC 7 MC 8 MR 8 CT 8 TR 8 KA 8 FM 8
OS 6 MC 7 MR 7 CT 7 TR 7 KA 7 FM 7
SC 6 MC 6 MR 6 CT 6 TR 6 KA 6 FM 6
OS 5 SC 5 MC 5 MR 5 CT 5 TR 5 KA 5 FM 5
OS 4 SC 4 MC 4 MR 4 CT 4 TR 4 KA 4 FM 4
OS 3 SC 3 MC 3 MR 3 CT 3 TR 3 KA 3 FM 3
OS 2 SC 2 MC 2 MR 2 CT 2 TR 2 KA 2 FM 2
OS 1 SC 1 MC 1 MR 1 CT 1 TR 1 KA 1 FM 1

OS Organizational SC Self MC Maintenance MR Mechanics CT Community TR Transportation KA Kitchen Tools FM Food & Meal
Skills Care & Cleaning & Repairs Travel & Appliances Planning

Copyright © 2018 by Functional Living Skills

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Learner: ____________________ Assessment of Functional Living Skills
Assessor Date Color Code
Skills Tracking System
Independent Living Skills

ST 34 IR 34
ST 33 IR 33
ST 32 IR 32
ST 31 IR 31
ST 30 IR 30
PM 30 ST 29 IR 29
MM 30 PM 29 ST 28
MM 29 PM 28 ST 27 SI 29 IR 28
MM 28 PM 27 ST 26 SI 28 IR 27
MM 27 PM 26 SI 27 IR 26
MM 26 ST 25 SI 26 IR 25
MM 25 PM 25 ST 24 IR 24
MM 24 PM 24 ST 23 SI 25
PM 23 SI 24 IR 23
MM 23 PM 22 ST 22 SI 23 IR 22
MM 22 PM 21 ST 21 SI 22 IR 21
MM 21 PM 20 ST 20 SI 21 IR 20
MM 20 PM 19 ST 19 SI 20
MM 19 IS 20 PM 18 ST 18 PS 19 SI 19 IR 19
MM 18 IS 19 PM 17 ST 17 PS 18 SI 18 IR 18
MM 17 IS 18 ST 16 PS 17 SI 17 LO 18 IR 17
IS 17 PM 16 ST 15 PS 16 SI 16 LO 17 IR 16
MM 16 IS 16 PM 15 ST 14 PS 15 LO 16 IR 15
MM 15 IS 15 PM 14 ST 13 SI 15 LO 15
MM 14 IS 14 PM 13 ST 12 PS 14 SI 14 IR 14
MM 13 IS 13 PM 12 ST 11 PS 13 SI 13 LO 14 IR 13
MM 12 IS 12 PM 11 PS 12 SI 12 LO 13 IR 12
MM 11 IS 11 PM 10 ST 10 PS 11 SI 11 LO 12 IR 11
IS 10 PM 9 ST 9 PS 10 SI 10 LO 11 IR 10
MM 10 IS 9 ST 8 PS 9 LO 10 IR 9
MM 9 PM 8 PS 8 SI 9 LO 9
MM 8 IS 8 PM 7 ST 7 PS 7 SI 8 LO 8 IR 8
MM 7 IS 7 PM 6 ST 6 SI 7 LO 7 IR 7
MM 6 IS 6 ST 5 PS 6 SI 6 LO 6 IR 6
MM 5 IS 5 PM 5 PS 5 SI 5 LO 5 IR 5
MM 4 IS 4 PM 4 ST 4 PS 4 SI 4 LO 4 IR 4
MM 3 IS 3 PM 3 ST 3 PS 3 SI 3 LO 3 IR 3
MM 2 IS 2 PM 2 ST 2 PS 2 SI 2 LO 2 IR 2
MM 1 IS 1 PM 1 ST 1 PS 1 SI 1 LO 1 IR 1

MM Money IS Independent PM Personal ST Safety PS Problem SI Social LO Living with IR Interpersonal

Management Shopping Management Solving Interactions Others Relationships

Copyright © 2018 by Functional Living Skills