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  2. 2017
  3. March
  4. O
  5. O & M Assessment
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* Date of assesment:
MonthDayYear
  
 
 
 
* Client name:
   
 
 
 
Orientation and Mobility Assessment
 
 
 
Assessment scale:
0=No knowledge/understanding
1=Introduced but limited knowledge/understanding
2=Basic knowledge/understanding (emerging skills)
3=Working knowledge (working skills)
4=Knows and can function independently (mastered skills)
 
 
Please rate the following basic skills.
04
No knowledge Introduced Emerging skills Working skills Mastered skills
Utilize protective techniques
Utilize hand trailing
Utilize direction trailing
Orient to room
Use search patterns for locating dropped items
 
 
 
Basic skills notes:
   
 
 
Please rate the following orientation skills.
04
No knowledge Introduced Emerging skills Working skills Mastered skills
Attain body awareness
Attain sensory awareness
Utilize spatial concepts
Utilize landmarks, clues and cues
Utilize compass directions; including directional corners
Utilize sun and wind
Acquire knowledge of indoor numbering system
Acquire knowledge of outdoor numbering system
Orient in a building
Gain concept of block, grid patterns and route patterns
Utilize problem solving techniques
 
 
 
Orientation skill notes:
   
 
 
Please rate the following human guide skills.
04
No knowledge Introduced Emerging skills Working skills Mastered skills
Accept or refuse aid
Make contact, grasp or use proper stance
Negotiate narrow passageways
Reverse directions
Transfer sides
Navigate stairs
Negotiate stairs
Enter a car
Instruct friends, family and others
 
 
Please rate the following basic skills.
04
No knowledge Introduced Emerging skills Working skills Mastered skills
Utilize protective techniques
Utilize hand trailing
Utilize direction trailing
Orient to room
Use search patterns for locating dropped items