Date: __________________________________  Date: __________________________________ 

Started on time/straight to work  Started on time/straight to work 

Morning  Y / N  Morning  Y / N 
   

Afternoon  Y / N  Afternoon  Y / N 

Achieved all their goals:  Achieved all their goals: 

Y / N  Y / N 

No reminders to be on task  No reminders to be on task 

Morning  Y / N  Morning  Y / N 

Afternoon  Y / N  Afternoon  Y / N 

3’s and 4’s  3’s and 4’s 

Y / N  Y / N