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100% found this document useful (10 votes)
33K views28 pagesVineland Adaptive Behavioral Scale - (Parent Caregiver Form)
Uploaded by
rajapakserakhithaCopyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
/ 28
Vineland-3
Vineland Adaptive Behavio
Parent/Caregiver Form
Separate the outside pages (pages 1-2 and 27-28 containing the Scoring Criteria)
from the rest of the booklet by gently pulling them off at the
aa iliac HI ©
BAAN ivrrai toca spelen my te erosces a vasnrnes samen crocsy Psyc
4nd retrieval system, witnout the express written permission ofthe copyright awe.
For inguties and reordering: Pearson, PST design, PsychCorp, and Vineland are trademarks, in the US ano/or other
800.627.7271 countries, of Pearson Eaueatlon, Inc, or ks aflate()
‘wewPeorsenciniesiom Ne Pearson, Inc. 5601 Green Valley Drive Bloomington, MN 55437
Printed in the Unitea States of America,
456789101112 BCOE Product Number 31326 LISTENING AND UNDERSTANDING
19. Other examples include fingers apart to show this small,
holding nose to show chat stinks, and shrugging shoulders to
‘mean I don't knove
23, 24. Ifhe/she sometimes does it without reminders but
sometimes needs reminders, score 1.
26. A“show” includes a TV show, video, live performanee, or
other entertainment.
29,31. Ifhe/she sometimes does it without reminders but
sometimes needs reminders, score 1.
33. A‘show” includes a’TV show, video, live performance, oF
other entertainment.
34, If he/she sometimes does it without reminders but sometimes
needs reminders, score 1.
37, Examples of informational talks are school and community
lectures, educational TV shows and videos, religious sermons,
sand meetings.
38. If he/she sometimes does it without reminders but sometimes
needs reminders, seore 1.
39. Examples of informational talks are school and community
lectures, educational TV shows and videos, religious sermons,
sand meetings.
TALKING.
6, Other examples are pushing something away, crying,
bouncing up and down while smiling, and clapping.
9-11, 15-17. He/she does not have to say the words perfectly.
18, He/she does not have to say the name perfectly.
19, 24, He/she does not have to say the words perfectly.
25-27. His/her sentences do not have to be perfect.
32. He/she does not have to say the names perfectly.
40. The story might be from a fairy tale, a book, ora movie,
READING AND WRITING
8, #.[¢s OK if he/she writes some letters backwards.
11. IFhe/she does not write alphabet letters, score 0.
15. It’s OK if he/she writes some letters backwards.
16. He/she may make small spelling errors.
17, He/she mast get most of the words correct.
18. His/her sentences do not have to be perfect.
19. He/she may make small spelling errors
22. His/her sentences do not have to be perfect.
25. [he/she sometimes does it without help but sometimes needs
help, score 1
27. His/her sentences do not have to be perfect.
28. If he/she sometimes does it without help but sometimes needs
help, score 1.
29, Ifhe/she sometimes does it without reminders but sometimes
needs reminders, score 1.
30, 31, Ifhe/she sometimes does it without help but sometimes
needs help, seore 1.
32. The instructions must be accurate,
33, 35, 37, 38. [f he/she sometimes does it without help but
sometimes needs help, score 1
2 Vineland-3. Comprehensive Parent/Careier Form
CARING FOR SELF
7-9, 11-15, If he/she sometimes does it without help but
sometimes needs help, score 1
16. IF he/she sometimes washes and dries without help but
sometimes needs help, score I
17, 19. Ifhe/she sometimes does it without help but sometimes
needs help, score 1.
20. If he/she sometimes does it without help or reminders but
sometimes needs help or reminders, score 1.
21. Ifhe/she sometimes does it without help but sometimes needs
help, score 1.
23. Score 2 if he/she does not have accidents during the day. Score
1 if he/she has some accidents during the day. Seore 0 if he/she
has many accidents during the day.
24, If he/she sometimes does it without help but sometimes needs
help, score 1.
25, 26. Ifhe/she sometimes does it without help or reminders but
sometimes needs help or reminders, score I
27. If he/she sometimes washes and dries without help but
sometimes needs help, score 1
28, Score 2if he/she does not have accidents at
he/she has some accidents at night. Score 0 if
accidents at night
29. If he/she sometimes does it without reminders but sometimes
needs reminders, score 1.
30. If he/she sometimes does it without help but sometimes needs
help, score 1.
31. If he/she sometimes does all ofthe steps without help but
sometimes needs help, score 1.
32, If he/she sometimes does it without help but sometimes needs
help, seore 1.
33. Score 2 if he/she does not have accidents during the day or at
night. Score 1if he/she has some accidents during the day or at
night, Score 0 if he/she has many accidents during the day or
at night.
34. If he/she sometimes does it without help but sometimes needs
help, score 1.
35. Lf he/she sometimes does it without help or reminders but
sometimes needs help or reminders, score 1.
36,38. Ifhe/she sometimes does it without help but sometimes
needs help, score 1
39. If he/she sometimes washes and dries without help but
sometimes needs help, score 1.
40, 41. Ifhe/she sometimes does it without help but sometimes,
needs help, score 1.
42. If he/she sometimes washes and rinses without help but
sometimes needs help, score 1.
43. If he/she sometimes does it without help but sometimes needs
help, score 1.
44. If he/she sometimes does it without help or reminders but
sometimes needs help or reminders, score 1
out help but sometimes needs
t: Score Lif
she has many
45. Ifhe/she sometimes does it
help, score 1.
46. If he/she sometimes does it without help or reminders but
sometimes needs help or reminders, score 1.
49. If he/she sometimes does it without being reminded or told
but sometimes needs to be reminded or told, score 1. Name ofthe Person You Are Describing: _
The Peson You are Describing isa: CI Female CI vale Persons Age
YourName:_
DIRECTIONS
COMPREHENSIVE
_— TodaysDate: __
_Person's Birth Date:
Your Relationship tothe Person: C1} Mother C1 Father C1 other 4
This form asks about the adaptive behaviors of the child or adult on whom you are reporting. Adaptive behaviors
are the day-to-day things that people do to communicate, take care of themselves, and get along with others.
Here is a sample item from the section called Caring for Self:
aries
Response Options: 2=Usualy or fen, 1
PO)
fometines, 0=Never
25. Wipes or cleans hier fice and his/her hands when eating someting mes.
Read each item and choose the score that best describes
what the person does on bis/ber own, without needing help
or reminders.
SCORING
Score each item 2, 1, or 0 as follows:
2= Usually or Often. Circle 2 if the person usualy or often
performs the behavior without help or reminders. (Or if he/she
hhas outgrown the behavior—see below)
1 = Sometimes. Circle 1 if the person sometimes performs the
behavior without help or reminders.
= Never. Circle 0 if the person never performs the behavior, or
never performs it without help or reminders. Some reasons why
you might give a score of O are:
+The person has not learned the behavior.
+ The person is not physically able to perform the behavior
+ The person is not expected or allowed to perform
the behavior.
+ The person can perform the behavior, but chooses not to.
Ifyou are not sure how often the person performs a behavior,
make your best guess. In addition to circling the item score,
also check the box to the right of the item score in the
column labeled Check if Est. (Est stands for Estimated.)
If the person performed a behavior when he/she was
younger, but has now outgrown it, score 2. De not check the
Estimated box.
Some items include a Scoring Tip, shown in gray underneath
the item text, and marked by the symbol {2 . Use the tips to
help you score those items. For example, some items have a
Scoring Tip that tells you to use a different way of scoring:
2= Yes, 0 = No
‘The pull-off pages labeled Scoring Criteria have more
information about scoring some of the items.
WHICH ITEMS TO ANSWER
‘The person who gave you this form may have crossed out one
or more sections. Just skip any crossed-out sections. You must
complete all of the sections that are not crossed out.
In each section that is not crossed out, you will see that an
item has been circled. Start with the circled item in each
section—you don't have to answer any items before the
circled item. Keep answering items until you have given five
scores of 0 in a row. When that happens, stop and go on to
the next section. If you have answered the items up to the end
of a section and still don’t have five Os in a row, it’s OK—just
{go on to the next se
Vineland-3 CompreensiveParentCregiver Form 3 Noe sr TTT
HEBD 1. Looks at you whem he/she hears your voice. 2100
2, Looks at you when you wave o get his/her attention 2100
3. Looks when someone calls his/her name. 2100
4. Unies ening ofl the bask sues Eras Herd od fry esd sak or nba foreirme 9 4 gL
reaching coping
5. Understands at lest 1 ord
1 Score 2 for Yes or 0 for No. 200 Y
‘6. When you look or point at something, looks in that direction. 21000
7, Follows directions to do one simple thing, Examples: “Sit down,” “Come here.” 2100
8. Understands yes. 2100
9, Respond he on your vod Example Heli ponds dic whenyoneny"Conchenwitslovogione pg g F]
than when you say twith an angry tone.
“10. Understands na
HEBD 11. Poines coat ease thee real objets when you ask. Example: A dog
12, Follows directions to do something with one object. Examples: “Bring me the book,
13. Unt thmening ares ss cl express on ters: Expl: ro, le pido angie a
14 Knosatas dec ofiser on prs Example Showssou her arm hen oh a
fe eee aeo
16 Postar leas he abso pcre when yuck: Expl Acar Ao
is aa lyr hon cra who a: pl Bonn ried
18, Answers questions hat se shar Example: You ask"What a this Hee saya” ball™ tie OD
HED 1, Unicsnis tc mening olen thee wre danced eur Examples Mainingonel Fagerontip mening yg [)
tei hnds sur toow tig
20, Ansys qetns thas le, Engl Vouk Whee dil alpe go Hehepinswhew Fapewent ——~=~SC* 0
21 Pino st asthe ass show inte whe ona: xan: Semen eng ried
22. Annes qn th Es: Youaok"We hat Hele ssa Kesha PieO
23, Fallows diretions todo two things that go together. Examples: "Pick up chore toys and put them away"“Getyourcostand yg
2 Faldo he hig i i ang Big hese a 5
te cath peace ease ipeaitncbynsuats ma)
26, Payateton os show frat et. instead understands whi happening Bago
27 Follows“ the dvecon. sample you thingy. then ptadenk"youare cal thengetaswenshie®™ «2 0
28, Anonersquion hat eh. Examples You ask Why ae you eying? Hee ay? My ey ke” Fat
29 Follow divecton odo wo things hat do ogo gether Esample“TunotTihe TVandgetmpiew” SSC © ED
4 Vineland-3 CompreensveParentCareiver erm LISTENING AND UNDERSTAND ROI)
Out
Response Options: 2= Usually or Often, 1 = Sometimes,
30. Answers questions that use when. Example: You ask “When do you eat breakfast?” He/she says “In the morning.”
31, Follows three-step directions. Example: “Get dressed, eat breakfast, and brush your teeth.”
32. Knows left and right on his/her body.
33, Pays attention toa show for at east 60 minutes and understands what is happening.
34, When cold to do something a ite later, eamembers to doit. Example: “When your show i over, putyour dishesinthesink.” 2 1 9 (]
35, Follows directions involving left and right. Examples: “Go tothe left,” “Look tothe right.” 2100
dk was rope ness when heya ign Ean Koome when Thaltinigen lyme py g Ey
-minute informational talk and understands what is being said. 21
37, Pays attention to
38, When told to do something much later that day, remembers t doit, Example: "When you get home from school,
let the dogout.”
39, Paysattention 1030.
CammentsorObserrations
Response Options: 2.=Usulyer Often, 1=Sometins, 0=Never
HED 1 Makes happy sounds Prod
2, Males sounds ogetures wget your attention moO
3, Makesat cast thre shor spech sounds, Examples*Mah,“Bah,"“Ee"Oh
@ Score 2 if he/she did this when younger, but now says words. 2100
4. Cres or fuses when hehe hungry, wets
© Score 2 if he/she did this when younger, but has now outgrown it. 2100
5, Babbles in ering founds. Examples: “Baba ba-b,"*Maca-macma"-Da-da-da da”
© Score 2if he/she do 2100
6: Makes sounds or gestures ife/she wantan activity to kep going or stop. Examples Say"Agninshakesheadma——~—~O« 10
7, Makes teas three basi gestures such as these: (2) Nodding head up and down frye 2) Shakinghead for no eo
{) Reaching for something waned, ) Waving a people, ) Clapping hands,
8. Says Daa’ o¢ “Mama” or another name fo pares il O
| 9, Says the names oft least three objects. Example: A ball ana 2100
Yo. Repeats or tres to epeat words fier hearing them Example Ball;CanMo. 5,
1 Score 2if he/she did this when younger, but has now outgrown it. 2100
HEED 11. Says the names fat least 10 objec so
Score 2 for Ye
Vineland-3 Comprehensive Parent/CregiverForm 5 ad DOLE
Response Options 2=Uoaj oon, 1=sonns, 0 Hoe
12, Says "No.” Must actually mean no, not just repeat the word. 2700
13, Says one-word requests. Examples: “Want,” “More,” “Open.” eo
Score 2 heshe did this when younger, but has now outgrown
1H, Says "Vea" Must actually mean ye, no just repeat the word 2100
415, Says the names of at least three actions. Example: Eat (or eating).
16, Calls brothers sisters, oF friends by their name oF
17, Says at east 50 words,
© Score for Yes or 0 for No.
18, Says his/her own first name or nickname.
19, Says things using both a noun (a naming word) and a verb (an action word). Examples: “Mommy stay?""Give ball”
20. Knows how to say more than one of something. Examples: “Two cats” "More crackers,”* Those flowers.”
21. Uses the pronouns J, me, and mine to refer to himself/herself. May make mistakes like “Me want” or “Mine toy.” 2100
22, Maer re me and ere char eC) Noting rs wtb) Pang ogee gg Cy
item thon ope i hao rtm rs
23. Uses words that show who something belongs to. Examples: “This is mine," *Your book,
"24, Uses adjectives to describe things. Examples: “Pretty picture,"“Big doggie.” oa O
25, Uses no and notin sentences. Examples “He docs not wantit;”"Me no go.” 2100
‘Dan read me a book."
A026, Napoca acne eae" cag 2100
27, Uses i, on, and underin sentences, Examples: “I'sin the box,” “Ball go under table.” 2100
Ti, hola Gaetan bag val aoa Eealaa Wien we ma O
Uses andin sentences. Examples:*Mom and Dad are here;"“I want ie cream and cake.” 2100
Says how old he/she is when you ask. Holding up fingers counts. a
Uses the pronouns you bese, im, and ber wo refer to other, May make mistakes ike “Heris happy” or‘T se he 2100
32, Says both his/her first name and last name when you ak, eee 2100
23, Asks questions that begin with sey. Examples: Why do [have to go?";"Why did you put mystuffeway” = SQ
34, Asks questions that begin with soem. Examples: “When is dinner?" “When can we go home?” 2100
35. Knows how to say that something happened in che past. Examples: *I walked to the store,” “Molly Baked cake.”
36, Uses all pronouns (words that refer to himself/herselfand others) correctly: Examples: J, he, 1s, them, your, our, ber
Hig ed hi kao abe eo
38 Says how ld he/the willbe at his/her ext birthday when you ask Holding upfingerscounts ire oo
139, Uses becasein sentences. Examples: “Tim going because T want co"*Kathy went home because she was sick.” 2400
40, Tells the basic parts ofa well-known story: The characters, what happens, how itends, et.
41, Uses behing in fromt of and betsce Tervel
went between the cars.
sentences. Examples:
behind you," “walkedin frontofher*Theball 5 y gC]
a2. ie ene Menno cna Examples: “The bathrooms atthe end of che hall," “Fold this over, ae O
5 Vinelané-3. Comprehensive ParetCaregiver Frm OTT
TNS i
One
Response Options: 2= Usually o Often, 1 = Sometimes, O= Never “it
43, Tells about one-time events in detail. Example: When someone asks him/her about atrp. roo
Gi, Uses two-part sentences joined by andor du, Examples: “She asked me, and Lold heeno"; “Jerome wanted ogo, oO
but I didn'e” ae
45, Tellsabout his/her everyday events in detail. Example: When you ak what happened at friend's house today: 2100
lay of his/her birthday when you ask. 2100
something ina different way if needed to help someone understand what he/she means. 2100
448. Says his/her complete home address correctly when you ask. Must include city and state. 2100
49, Gives complex directions with three or more steps. Examples: “Go to the end of this street, turn right, and go half a block
sent ys a Gnooocy whine bullllag’y Firwesek the nota; ther terthecs ix per with che paneé,xad thea pacts (A Cl]
crumbs on top and bake for 10 minutes.”
Comments or Observations:
See “aeltin of 9 eal Taw soe laation
Fighest Numbered
r No.of Et 4 Basel ter Pee J
Pra No.of tems Answered , Points Between Basal and Ceing| fl
(A+B) x 100 = il exphanser| |
READING AND WRITING: COMMUNICATION DOMAIN
Response Options: 2=Usalyor Often, 1.=Sametins, 0= Never te
= 1, Holds a book correctly for reading and turns the pages from front to back. 21:00
f teennmaniyiciaieanaiarioliccece — — ao
3, Understands one or more simple signs and symbols. Examples: STOP signs, bathroom door signs, arrows, 5 2100
4, Recognizes his/her own name in printed form, ee 2100
5 Kowa alae vhen tiie =o
é. Kw 2100
HEED 7 Wenn de core direction Example: rom cig in Engin Fy
8, Copies his/her own first name without mistakes
9. Copies simple words without mistakes. Examples: CAT, SEE, GO.
Score 2itheshe did this when younger, buthas now outgrown it
10. Knows all alphabet letters, bth uppercase and lowercase, when he/she sees them
Score 2for Yes oF 0 foe No
Ti, Wet sebet cor erro ncrnenlat peed
12, Writes both his/her first and last name from mem
13, Readsat least 10 words,
12 Score 2for Ys or 0forNo
Vinelad-3 Comprehensive PorntCregiver form 7 PELOTON a RIMM
espn pis 2= oar, =Soeins, 0 er
T7714 Reads simple sentences of three or more words outloud. a | | 6h
HELI 15. Copies sentences of four oF more words without mistakes
Score he/she did this when younger but has now outgrown
16, Writes at least 10 words from memory. Examples: HAT, BALL, THE.
& Score 2for Yes oF 0 for No.
2100
7 0
17, Reads simple stories out loud. z
2100 |
Score? fheshe di this when younger, but has ow outgrown it
SE Welt vac ie eer ro
Ww Ghani eocs oa ow
20, Reads ata second-grade level or higher.
Score 2for Yes orOforNa
alphabetical order. Examples: Finds a name in an address book or lst of phone numbers, finds a word in ae
Is, or cexts that are three sentences or more.
22, Writes simple notes, letters,
& Score for Yes or OforNo.
23. Understands simple tables, ge
1 or charts. 2100
24 Understands vial nvracdons: Examples Awenbly istration diecoans shown nmap. Peo
that are at least three sentences. Must use his/her own words and not copy.
25, Writes reports or summ:
@ Score 2fheishe dd this when younger, but ow does not need to write report
26, Reads ata fourth-grade level or higher
200
& Score for Yes or for No.
27, Writes emails, stories, levers, journal entries ee. that are 10 sentences or more.
© Scare 2 for Yes or Ofor No
28, Uses atable of contents or index to find information within a book or electronic file. 2100
129, Checks and corrects his/her written work before handing it in. Example: Checks spelling using computer.
& Score fhevshe dt this when younger, but naw does not need to hand in written work,
30, Uses the Internet ora library to find information for writing a paper or completing a job assignment. 2100
31, Writes papers that are at least one page long, Must use his/her own words and not copy.
51 Score 2 he/she ald this when younger, but now does not need to wre papers.
32. Writes or draws instructions fr others, Examples: How todo something, how to get somewhere.
33. Fills out paper or electronic forms of one page or less. Example: Forms for school or work.
34, Reads ata sixth-grade level or higher.
1 Score 2for Yes Dfor No,
135, Writes papers that are at last three pages long. Must use his/her own words and not copy
1 Score 2ifhe/she did ths when younger, but now doesnot need to wre papers
36, Reads at ninth-grade evel or higher
1 Score 2for Yes or Ofor No aoe CO)
37, Fills out pape or electronic forms of two pages or more. Examples: Applications fora job, college, or credit ard 2100
38. Writes business or application letters. Examples: Requests information, makes a complaint, applies forajobortoaschool. 24 9 []
8 Wineland-3. Comprehensive Parent Caregiver Form PEIN e OUI
Commenter Observations:
"Galeaaton of Wt see Noe Raw Score Gleation
Fighest Numbered
Basal tom
No.of Ex
x25)
No.of tems Answered| Points Between Basal and Ceing|
(A+B) x 100 =
Nae
HEED 1 Opens histher mouth when else being ed.
2 Score2it hein di shen yours ths oun bing fe
2. Drinks froma bottle or sippy cup. Must hold the bottle or cup without hel
1 Score 2t he/she di this when younger, but has now outgrown
3, Eats solid foods. Examples: Cooked vegetables, chopped meats.
sf 2100
4, Cooperates when you undress and dress him/her. Examples: Raises arms for taking off top, holds out feet for putting on
‘pants or shoes.
Score 2if he/she di this when younger, but has now outgrown
5, Sucks or chews on finger foods. Examples: Crackers, cookies toast.
6. Cooperates when you wash his/her hands and face. Examples: Holds out hands, turns face toward you
& Score 2 heshe dé this when younger, but has now outgrownit
7, Feeds himself/herself with a spoon. May spill.
8, Takes off his/her shoes and his/her socks.
9, Drinks froma regular cup or glass. May spill.
HEE} 10. Less someone know when he/she has «wet or dirty diaper or pans.
Score 2it he/she this when younger. but nove ses the tlt.
11, Feeds himself/herself with a fork. May spill.
12, Takes offelothing that opens in the front. Does not have to unbutton or unzip it. Example: A jacket.
13, Pulls up clothing that has elastic around the waist. Examples: Underwear, sweatpants
14, Drinks from a regular cup oF glass without spilling,
15, Feeds himself/herself with a spoon without spilling
16, Washes his/her hands using soap and water and dries them. Does not have to turn the water on and off
17, Takes off pullover clothing, Examples: T-shirt, sweatshirt, dress,
18, Urinates (goes pee) in a toile or potty chair.
19, Puts om his/her shoes. Shoes may be on the wrong feet, and he/she does not have to tie or fasten them,
"20, Wipes or lows his/her nose using tissue, napkin, et.
“21, Pats on clothing that opens inthe front, Does not have to zip or button it. Example: A jacket.
Vineland-3 Comprehensive PorentiCregiver form 9 CARING FOR SELF
22, Defeeates (goes poop in a toilet or potty chai
123, Uses the toler during the day. May need help, but must know when he/she needs to go.
24, Putson pullover clothing, Examples: Thi
25, Wipes or cleans his/her face and his/her hands when eating something messy.
HEHIp 26, Pus clothing on with right ie Frward nd corres id out,
27, Washes and dries his/her face. Does not have to turn the water on and off.
28. Uses the toilet at night, May need help, bur must know when he/she needs to.
129. Covers his/her mouth and nose when he/she coughs or sneezes
Fastens snaps. ae
. Brushes his/her teeth. Must pur toothpaste on toothbrush, brush well, and rinse.
lib 24 Becca trpotercsta te oct Esa Cntbeaoans
35. Changes clothes that have gotten dirty, wet, muddy, or smelly
37, Knows that exercises good for people.
40, Buttons smal buttons in the correct holes. Example: Shirt buttons.
41, Finds and uses a proper restroom when away from home.
42. Washes and rinse his/her hair. Does not have to turn the water on and off.
43, Turns faucets on and adjusts the water temperature
46, Selects proper clothing when is rainy or old, Examples: Raincoat, boots, sweater
47, Knows which foods ar ealthy and unhealthy.
48. Chooses o exercise for health or enjoyment.
“49, Chooses to eat healthy foods.
"50, Plans for changes in weather by raking along an umbrella,
51, Cuts harderto-cut food with a sharp knife, Examples: Meat raw vegetables.
52. Goes to the doctor when he/she needs to because of sickness or injury.
53, Takes medicine as directed on his/her own.
10 Vineland-3 Comprehensive Porent/argiverFom
36. Connects and zips zippers that are not already fastened at the bottom. Examples: Zippers on a coat or jacket.
CT
Usually or Often, 1 = Sometimes,
|
ooo0o0o000 Narre ATT
‘Ont
Response Options: 2=Uualyor Ofte, 1 = Sometines, = Never i
7 Z 2100
Takes his/her own temp
55. Keeps track of his/her medicines and refills them when needed.
Ir he/she has not had to keep track of medicines and refill them by himself/herself, quess how often he/she would do it. 2100
Algo check the Estimate box.
Comments or Observations
Towa aan
A = Basal Item | x2= J
J] romsbecneentaand cag
PerfowScor| —o.
PON POT
Response Options: 2 = Usuallyor Often, 1
HE Be careft around things that could burn him/her. Examples: Stove, oven, fir.
2, Iscareful when using sharp objects. Examples: Knives, scissors
3, Wipes up his/her own spills.
4, Puts his/her dirty clothes inthe proper place to be washed. Exampl
aaundry basket, laundry chute.
