Assistive Technology Evaluation

 

ASSISTIVE TECHNOLOGY EVALUATION

 

Name:                                        FirstName LastName

Date of Evaluation:                                                                     

VR Counselor:                          

Evaluator:                                                                                   

REASON FOR REFERRAL

FirstName LastName was referred to the Assistive Technology Team at the Institute for Human Development Assistive Technology Center (IHDATC) by Vocational Rehabilitation or other referral source to determine appropriate assistive technology systems and techniques that will assist him/her in __________. FirstName was seen at _________ in _______ to discuss his/her needs for access within his/her ____________ and to review what accommodations/adaptations he/she is familiar with and has used.

 

DIAGNOSIS

FirstName was involved  or diagnosed with ….

HEARING AND VISION STATUS

FirstName appeared to have functional/difficulty hearing during the evaluation session. He/she responded to conversation at normal? loudness levels.  He/she does/does not wear glasses and did/ did not appear to have any apparent difficulty with his/her vision during the interview session. FirstName stated that he/she does/does not have any significant difficulties with vision or hearing.

 

MEETING/ASSESSMENT

FirstName  (include general information regarding the client – either from the paperwork submitted prior to assessment or from the client interview)

For an AT assessment, the Client, Environment, Tasks, and Tools (CETT) format was used to evaluate FirstName and to determine appropriate assistive technologies relevant to the specific needs, his/her specific environments, and the tasks, which need to be completed.

 

Client

In considering the individual client, the evaluator addressed the following questions: What does FirstName need to do? What are his/hers special needs? What are FirstName’s current abilities? What are FirstName’s abilities and interests in the area of computers?

Environment

 In considering the environment the evaluator addressed the following questions: What is the arrangement of the work environment? What materials and equipment are available in the work environment? What attitudes are present about assistive technology? And technology in general?

Describe the environment including the physical environment(s) and others that may be involved with the client for the activities indicated in the report.

Tasks

In considering the tasks the evaluator addressed the following questions: What are tasks which others complete to enable independence and vocational progress? How do others complete these tasks? What are the critical elements of the tasks?

The identified needs for FirstName are to

   (list as many tasks that you can identify that the client will need to do in the context of independent living, school, work, etc. You may also identify tasks in more than one category.)

 

Tools

In considering the tools, the evaluator addressed the following question: What tools may be used to complete the tasks? Services to assist in the successful implementation of the assistive technology tools are also discussed in this section.

Following the request of VR Counselor or referral source that an AT assessment be completed for ______ activities for FirstName and given FirstName’s goals of being _______  his/her tasks, his/her ________ needs to be adapted to:

  • List the reasons for the adaptations
  •  

It was determined that FirstName, considering his/her ? tasks, should have the following tools and/or adaptations to ?.

            List general categories of AT tools here

SPECIFIC RECOMMENDATIONS (list of specific devices and components with ordering information)

It was a pleasure working with FirstName. If you have any questions regarding this evaluation, please feel free to contact us at ______.

______________________________                                                      

Assistive Technology Specialists 

Cc:    

The following checklist format may help organize the recommendations, making it easier for the client and counselor to prioritize the items-

CHECKLIST OF SUGGESTED AT TOOLS

 

AT TOOL

COST

VENDOR

YES

NO

DATE ORDERED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Advertisements