Job Coaching Monthly Report



Monthly Job Coaching Report Report Date: FORMTEXT ?????AFP # FORMTEXT ?????Participant’s Name: FORMTEXT ?????Participant’s Job Title: FORMTEXT ?????VR Counselor’s Name: FORMTEXT ?????Contractor’s Name: FORMTEXT ?????Employer’s Name: FORMTEXT ?????Employment Start Date: FORMTEXT ?????On-Site Job Coach’s Name: FORMTEXT ?????Job Coach’s Email: FORMTEXT ?????Job Coach’s Phone: FORMTEXT ?????On-Site Job Coach’s Name: FORMTEXT ?????Job Coach’s Email: FORMTEXT ?????Job Coach’s Phone: FORMTEXT ?????Job Coaching ProvidedDates and TimesActivities/Strategies UsedNumber of Hours Coached, i.e., 1.5 (during this reporting period) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Job ResponsibilitiesPlease describe successes and challenges with all strategies identified in the Job Coaching Plan: FORMTEXT ?????Did you notice any tasks or opportunities at the worksite the Participant could successfully complete, not originally offered by the employer? FORMCHECKBOX Yes FORMCHECKBOX No If yes, could this position be expanded for this participant? Please explain: FORMTEXT ?????Work BehaviorsGoals and Objectives for the next month: FORMTEXT ?????Forecasted Job Coaching Hours Request: FORMTEXT ?????Rationale and Timelines for Forecasted Hours: FORMTEXT ?????Accommodation Needs Identified FORMTEXT ?????Natural SupportsDiscuss progress and changes to natural Support Plan as reported in the Job Coaching Plan: FORMTEXT ?????Fading and Transition PlanDiscuss progress and changes to fading and transition plan as reported in the Job Coaching Plan: FORMTEXT ?????Submitted by: FORMTEXT (coach)Shared with: FORMTEXT (team members) ................
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