North Penn School District
Occupational Therapy Parental Input
Personal Responsibilities
I do this all
the time
I sometimes do
this
I need to get
better at doing this
Goal area
I do this all
the time
I sometimes do
this
I need to get
better at doing this
Goal area
Put my toys away
Get dressed and undressed by myself
Pick out my own clothes
Put my shoes and socks on
Put my clothes away (drawers & hanger)
Make my bed
Button my shirt
Zipper my jacket
Put mittens/ gloves on
Tie my shoes
Buckle a belt
Brush my teeth twice a day
Brush my hair
Wipe / Blow my nose when needed
Wash my face
Shower/ bath
Wash my hair
Wear deodorant
I get things ready for activities/ sports
I put things away after activity/ sport
Get myself a snack
Clean up my snacks
Make a simple, healthy meal
Clean up after snack/ meal prep
Turn off the TV when appropriate/ told
Be responsible for the time to come home
Other:
Other:
School-Related Personal Responsibilities
Give important papers to my parents
Do my homework at an appropriate time
Read
Keep school belonging neat & organized
Put my book bag away
Pack my book bag
Practice instrument
Other:
Other:
North Penn School District
Occupational Therapy Parental Input
Family Contributions
Early Elementary School Age
Put my toys away
Bring dishes to sink
Put my clothes away
Clean up after myself in family area/
bathroom
Make my bed
Get mail if safe
Set the table
Clear the table
Load the dishwasher
Unload the dishwasher
Use small vacuum
Meal prep
Take out small garbage/ recycle bin
Water plants
Feed pets
Wash dishes
Other:
Early to Middle Elementary School-Age
Walk pets
Sweep floors
Help younger siblings with chores/ homework
Help unload groceries
Help make dinner
Rake the yard
Sweep the sidewalk/ garage
Pull weeds
Wipe the bathroom/ Kitchen counters
Wipe the bathroom mirror
Fold laundry
Clean out microwave
Take out the large garbage/ recycles out to
curb
Organize kitchen drawers/ cabinet
Fold clothes
Other:
Later Elementary to Early Middle School-Age
Help clean the house
Mow lawn
Heavier yard/ house work (i.e. cleaning
garage or windows)
Wash/ dry laundry
Make simple meals
Other:
I do this all
the time
I sometimes do
this
I have not done
this yet
Goal area
Pick 3
North Penn School District
Occupational Therapy Parental Input