XXXXX    Workshop Data/ Progress Report Sheet   
Resident's Name:                                                                                                                     Data Collection
Month/Year:                                                                                                                                                        INT Date                             TGT Date       
                                                                                                                            EXT Date                            COM Date

Time Code                                                                                                                                                                     
Primary objective  - 1  A:                
Criterion:  @% Independent for  
consecutive                                                                                                                                                              
Methods:  Staff will:        A:   
8-9      1         9-10    2          10-11   3      11-12   4            12-1     5           1-2     6        2-250    7

Resident's Name:                                                                                                                     Data Collection
Month/Year:                                                                                                                                                      INT Date                             TGT Date       
                                                                                                                          EXT Date                            COM Date

Time Code                                                                                                                                                                     
Primary objective  - 1  A:                
Criterion:  @% Independent for  
consecutive                                                                                                                                                              
Methods:  Staff will:        A:   

Resident's Name:                                                                                                                     Data Collection
Month/Year:                                                                                                                                                         INT Date                             TGT Date       
                                                                                                                          EXT Date                            COM Date

Time Code                                                                                                                                                                     
Primary objective  - 1  A:                
Criterion:  @% Independent for  
consecutive                                                                                                                                                              
Methods:  Staff will:        A:   

Resident's Name:                                                                                                                     Data Collection
Month/Year:                                                                                                                                                         INT Date                             TGT Date       
                                                                                                                          EXT Date                            COM Date

Time Code                                                                                                                                                                     
Primary objective  - 1  A:                
Criterion:  @% Independent for  
consecutive                                                                                                                                                              
Methods:  Staff will:        A:   
8-9      1         9-10    2          10-11   3      11-12   4            12-1     5           1-2     6        2-250    7
8-9      1         9-10    2          10-11   3      11-12   4            12-1     5           1-2     6        2-250    7
8-9      1         9-10    2          10-11   3      11-12   4            12-1     5           1-2     6        2-250    7
Days
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Total(-)
Total (+)
+ (Yes) Or - (No)
                                                                 
Staff Initial
                                                              Divide (+) by (-)
Percent:
time code
                                                             
   
   
   
   
Date                                                                                                    Progress Notes:
   
   
   
   
Days
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Total(-)
Total (+)
+ (Yes) Or - (No)
                                                                 
Staff Initial
                                                              Divide (+) by (-)
Percent:
time code
                                                             
Date                                                                                                    Progress Notes:
Days
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Total(-)
Total (+)
+ (Yes) Or - (No)
                                                                 
Staff Initial
                                                              Divide (+) by (-)
Percent:
time code
                                                             
Date                                                                                                    Progress Notes:
Date                                                                                                    Progress Notes:
   
   
   
   
   
   
   
   
Days
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Total(-)
Total (+)
+ (Yes) Or - (No)
                                                                 
Staff Initial
                                                              Divide (+) by (-)
Percent:
time code