Menu

CBS Registration – Support Needs Assessment

Support Needs Assessment

Support Needs Assessment

Provide detailed information regarding support needs of participant.

The information you provide below will help us ensure that we have services and supports available to effectively meet your needs.

Where applicable, use the following information to specify the level of support required.
Support Level Key:
0 - N/A
1 - Independent - accomplishes tasks and activities safely
2 - Minimum – occasional verbal prompts
3 - Medium – continuous verbal and/or visual prompts
4 - Maximum – full assistance

Communication Support

Communication style *
If not applicable, enter n/a.

Personal Care Support

Personal Supports Required *

Mealtime Support

Please include any cultural, religious or other important food related considerations. If not applicable, enter n/a.
Please describe anything related to diet or eating habits including sensitivities such as color, texture, type, etc. If applicable, provide special instructions associated with meal times or food. If not applicable, enter n/a.
Mealtime Supports Required *

Behaviour Support

Behaviour Types *
Select all that apply
Please provide more detailed information on any of the selected behaviour types. If none, insert n/a.
Eg. animals, loud noises, strangers, etc. If none, insert n/a.
Behaviour Supports Required *
Participant uses or benefits from these supports:
Does participant have a Behaviour Plan? *
Upload current Behaviour Plan
Maximum upload size: 516MB
If not applicable, enter n/a
If not applicable, enter n/a.
Participant Interaction *
Who does the participant most like to interact with? Select all that apply.

Mobility and Transportation Support

If not applicable, enter n/a
Mobility Supports Required *
Transportation Supports Required *
HandyDART *
If not applicable, enter n/a.
HandyCard *

Safety Support

Safety Supports Required *

Social Interaction and Focusing

Social Interaction Supports Required *
Focusing Supports Required *

Activities and Motor Skills Support

All fields are required in this section.
Life Jacket *
Does participant require a life jacket when swimming?
Swimming Level *
Muscle Tone *
Energy Level *
Are there any other activities with which the participant needs support?

Further comments

won't you join us?

Each of us has a role to play in creating the community we want to live, work and play in. Join our email list to keep up to date on NSDRC news. Let's build a better community together!

North Shore Disability Resource Centre

3158 Mountain Highway

North Vancouver, BC

V7K 2H5

phone: 604-985-5371

fax: 604-985-7594

email: nsdrc@nsdrc.org

connect with us

United Way member agency

The NSDRC was started by a group of families in 1976. In the years since, we have worked for a "Community for All" by developing and providing residential services, infant development programs, youth groups, community based services, and information and advocacy.