3. DOMAINS ISSUES PLANS
SPECIFY WHO, AND WHEN
RECOMMENDATIONS WILL BE
ADDRESSED
COMMUNICATION
INDEPENDENCE/
PROBLEM SOLVING/
WORK HABITS
DAILY LIVING
SKILLS
PERSONAL CARE
SELF-CARE
TOILETING
DRESSING
MEALS
4. DOMAINS ISSUES PLANS
MOTOR SKILLS/
ACCESSIBILITY
SENSORY/
BEHAVIORAL
CONCERNS
SAFETY
PHYSICAL
EMOTIONAL
SOCIAL
5. DOMAINS ISSUES PLANS
PERSONAL &
SOCIAL
WELL-BEING
PHYSICAL HEALTH/
MEDICAL
COMMUNITY LIVING
SKILLS
PREVOCATIONAL/
VOCATIONAL NEEDS
LEISURE & RECREATION
MONEY MANAGEMENT
TRANSPORTATION
6. ASSISTIVE TECHNOLOGY
What is presently being used?
What is required in the new environment(s)?
PARENT QUESTIONS OR CONCERNS
OTHER CONCERNS, QUESTIONS, ISSUES
DATE OF NEXT MEETING (if required) ___________________________________
8. Following a round table of introductions, circulate this page around the table for those in attendance to complete
Team Members Involved and/or Present Involved Contact Information E-mail Address
Present
Student:
Parent(s)/Caregiver:
Classroom Teacher(s):
Student Support Teachers:
Administrators:
Student Services Coordinator:
Speech/Language Pathologist:
Occupational Therapist:
School Counsellor:
9. Team Members Involved and/or Present Involved Contact Information E-mail Address
Present
Health:
Social Services:
RIC/CBOs:
Corrections, Public Safety & Policing:
Other: