FRANKLIN ACADEMY
Self-Care Skills 2019
Student Name:
Date:
Rater:
Parent
Date of Birth:
Staff
Grade in Fall:
Student
Using the scale below, please rate the student's ability to perform each skill.
NI
1
2
3
4
5
6
No
Impression
Extremely
Poor
Poor
Emerging
Adequate
Good
Excellent
HYGIENE
Demonstrates knowledge of care for hair, body, nails
Engages in developmentally appropriate care for hair, body, nails
Manages clothing effectively
Recognizes and follows through with laundry needs
Manages laundry independently
HEALTH CARE
Understands importance and impact of sleep hygiene
Engages in sufficient sleep hygiene
Recognizes personal health needs such as illness, fever, or injury
Recognizes personal mental health needs, such as change in mood
Seeks assistance to meet personal health needs
Follows medication regimen
NUTRITION & EXERCISE
Understands the importance of nutrition on healthy functioning
Eats a balanced and proportional diet
Can identify the importance of physical exercise on personal health
Engages in a structured physical activity program
Creates and maintains a regular exercise program
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