Name:

_______________________

Washington County Job Development Program

Work Behavior Checklist

School Year: _______________________

1.
2.
3.
4.
5.

Work Behavior:
Work Communication Skills:
Individual Goal:
Quality/ Accuracy of Work:
Individual Goal:
Quantity of Work/ Productivity:
Individual Goal:
Response to Supervision:
Individual Goal:
Independence Behaviors:
Individual Goal:
Scoring Rubric:

Case Manager: _____________________

Marking Period: _____________________

Week # 1 Week # 2 Week # 3 Week # 4 Week # 5 Week # 6 Week # 7 Week # 8

5 = Strength/ Almost always displays behavior at acceptable level

4 = Minor Improvement needed/ Usually displays behavior at acceptable level
3 = Moderate Improvement Needed/ Sometimes displays beahior at acceptable level
2 = Major Improvement needed/ Occasionally displays behavior at acceptable level
1 = Rarely/Never displays behavior at acceptable level

Name:

_______________________

School Year: _______________________

Week # 9

Washington County Job Development Program

Work Behavior Checklist

Case Manager: _____________________

Marking Period: _____________________