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 file size: 52.43MB

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

Safety Support

Safety Supports Required *
Does the participant have a Safety Plan? *
Upload current Safety Plan

Maximum file size: 52.43MB

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

Supporting Documentation

If you have not yet done so, please provide any documentation that will help us provide your participant with the best support possible.
Does participant have any of the following documents?

Maximum file size: 52.43MB

You only need to upload your documents once. If you have already uploaded the document, you do not need to upload it again here.
Please remember to attach any relevant documentation to your registration.

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 community housing, infant development programs, youth groups, community-based services, and information and advocacy.

We are grateful for the opportunity to work, live and play on the unceded territory of the Coast Salish Peoples, including the territories of Musqueam, Squamish, and Tsleil-Waututh Nations.

Privacy Policy - Terms and Conditions