Printed on: {Report_CurrentDateTime}

 

Document Date {hm_date}
Original Work Location {hm_location}
Temporary Work Location {ReportLabel2}
Coordinator {hm_coordinator}
Individuals {hm_individuals}
In the Home.....
1. My discussed responsibilities for the upcoming week are: {hm_h_my_discussion}
2. On goings in the household that I am satisfied with (Ex.Housemates, Food Menu, Environment, Procedure etc.) {hm_h_ongoing1}
3. On goings in the household in which I would like to see changes made: {hm_h_ongoing2}
4. My accomplishments for the past week: {hm_h_my_accomplishments}
5. Things I need: {hm_h_things}
At Work/School.....
1. What I did at SChool/Work this week: {hm_w_what1}
2. Things in School/Work that I am satisfied with (ex.Transportation, Co-Workers/Classmates, Curriculum,/Tasks, Environment, Supervisors etc.): {hm_w_things1}
3. Things in School/Work that I have concerns about: {hm_w_things2}
In the Community.....
1. My Interest and Preferences are: {hm_c_my_interest}
2. Activities I would like to participate in thsi upcoming week/weekend: {hm_c_activities}
3. What Activities did I participate in this past week: {hm_c_what_activities}
Additional Comments (To be filled out by Staff if needed): {hm_addl_comments}
Follow up Action (To be filled out by Coordinator): {hm_follow_up}
Data Entered on: {ReportLabel1}
No records