Occupational performance analysis form
Priority occupation you are observing:
Date, time and place of observation:
Persons present:
| SATISFACTION WITH OVERALL OCCUPATIONAL PERFORMANCE | |
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Person’s
perspective
(captured
via interview)
How important is this occupation for the person? What is the purpose of this occupation? How satisfied is the person at present with their performance in this occupation? |
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Social
support’s perspective
(if
applicable; captured via interview)
How important is this occupation for relevant people in a close relationship to the person (e.g. family member, partner, friend, carer, support worker)? What is the purpose of this occupation? How satisfied is the supporter(s) at present with the person’s performance in this occupation? |
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Key
stakeholder(s) perspective
(if
applicable; captured via interview)
How important is this occupation for the any relevant stakeholders (e.g. other professionals involved with this person, service setting requirements)? What is the purpose of this occupation? How satisfied is the relevant stakeholder(s) at present with the person’s performance in this occupation? |
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| OVERALL PERFORMANCE (please circle) | ||
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Physical
effort or clumsiness
No increase Minimal Moderate Marked |
Efficiency
(disorganisation) in use of time, space or objects
Efficient Minimal Moderate Marked |
Social
appropriateness
Appropriate Minimal disruption Moderate disruption Marked disruption |
| Safety (risk of personal injury or environmental damage) Safe – minimal – moderate – marked |
Need
for assistance (independence)
Independent – Occasional – Frequent – Constant |
| SOCIAL INTERACTION SKILLS | ||
| Skill item | Please rate each skill item as: No problem Mild problem Moderate problem Severe problem | Comment: (qualify the rating you gave with a description of key observations) |
| Initiating and terminating social interaction | ||
| Approaches / starts |
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| Concludes / exits |
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| Produces social interaction | ||
| Produces speech |
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| Gesticulates |
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| Speaks fluently |
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| Physically supporting social interaction | ||
| Turns toward |
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| Looks |
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| Places self |
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| Touches |
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| Regulates |
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| Shaping content of social interaction | ||
| Questions |
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| Replies |
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| Discloses |
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| Expresses emotions |
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| Disagrees |
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| Thanks |
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| Maintaining flow of social interaction | ||
| Transitions |
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| Time response |
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| Times duration |
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| Takes turns |
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| Verbally supporting social interaction | ||
| Matches language |
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| Clarifies |
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| Acknowledges / encourages |
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| Empathizes |
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| Heeds |
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| Accommodates |
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| Benefits |
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| PROCESS SKILLS | ||
| Skill item | Please rate each skill item as: No problem Mild problem Moderate problem Severe problem | Comment: (qualify the rating you gave with a description of key observations) |
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Sustaining
performance
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| Paces |
Mild
problem
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| Attends |
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| Heeds |
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Applying
knowledge
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| Chooses |
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| Uses |
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| Handles |
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| Inquires |
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| Temporal Organisation | ||
| Initiates |
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| Continues |
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| Sequences |
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| Terminates |
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Organising
space and objects
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| Searches/locates |
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| Gathers |
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| Organises |
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| Restores |
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| Navigates |
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| Adapting performance | ||
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Notices/responds
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Adjusts
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Accommodates
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Benefits
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| MOTOR SKILLS | ||
| Skill item | Please rate each skill item as: No problem Mild problem Moderate problem Severe problem | Comment: (qualify the rating you gave with a description of key observations) |
| Body position | ||
| Stabilises |
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| Aligns |
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| Positions |
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| Obtaining and holding objects | ||
| Reaches |
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| Bends |
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| Grips |
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| Manipulates |
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| Coordinates |
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| Moving self and objects | ||
| Moves |
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| Lifts |
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| Walks |
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| Transports |
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| Calibrates |
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| Flows |
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| Sustaining performance | ||
| Endures |
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| Paces |
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| WHAT WAS THE ENVIRONMENTAL CONTEXT WHERE THE OCCUPATION TOOK PLACE? | |
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Describe
the social context where the occupation took place (consider using
a plan and description):
Ambiance
e.g. rushed or calm, hostile, sympathetic
Degree
of familiarity e.g. routine or novel tasks
Language
e.g. complexity, pace
Interaction
e.g. communication between people
Norms
and rules e.g. explicit and implied
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Describe
the physical space where the occupation was performed (consider
using a plan and description):
Visual
e.g. lighting, distractions
Auditory
e.g. noise level
Tactile
e.g. textures of materials
Movement
e.g. space to move, flow of movement
Temperature
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List
any equipment / tools / objects which were used.
Provide
a physical description of key objects
What
is the meaning of the object to the person (if relevant)
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