STUDENT INDEPENDENCE DATA
Statewide Autism Resources and Training Project (START)
Independence Data Sheet Examples of Routines
Table of Contents
1) Responding to a text using an iPhone
2) Toileting
3) Arrival
4) Navigating the hallway- classroom to bathroom
5) Lunch
6) Completing a worksheet
7) Following a visual schedule when making transitions
8) Buying food from a concession stand
9) Getting a book from the library
Student Name: __Adriana___Martinez______Observer 1: __Mrs. Trimmins______
Class/Teacher: _____Mrs. Trimmins______Observer 2: ______IOA: ______
Routine: ______Responding to a text using an iPhone______
KEY (definitions on back):
4=Independent 3=Visual / Gestural 2=Verbal 1=Partial or Full Physical S=Step not completed by student
Steps of Routine / Date1. When received a text message and it’s appropriate to text, tap circle button on bottom of the phone to turn on screen / 4321S / 4321S / 4321S / 4321
S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
S / 4321
S / 4321
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2. Locate message icon, and tap / 4321
S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
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3. Tap on the new text message (indicated by blue circle) / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
4. Read text message / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
5. Taps on box that states “text message” / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
S
6. Types an age appropriate, relevant reply to text message by tapping the phone keyboard / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
7. When done typing message, taps “send” / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
8. / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
Student Name: __Adriana___Martinez______Observer 1: __Mrs. Trimmins______
Class/Teacher: _____Mrs. Trimmins______Observer 2: ______IOA: ______
Routine: ______Toileting______
KEY (definitions on back):
Steps of Routine / Date1. Walk into bathroom stall / 4321S / 4321S / 4321S / 4321
S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
S / 4321
S / 4321
S
2. Pull pants down / 4321
S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
S
3. Sit down/Stand / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
4. Eliminate in toilet / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
5. Wipe (if applicable) / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
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6. Pull pants up / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
7. Zip or button pants (if applicable) / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
8. Flush / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
9. Wash hands / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
4=Independent 3=Visual / Gestural 2=Verbal 1=Partial or Full Physical S=Step not completed by student
Student Name: __Adriana___Martinez______Observer 1: __Mrs. Trimmins______
Class/Teacher: _____Mrs. Trimmins______Observer 2: ______IOA: ______
Routine: ______Toileting______
KEY (definitions on back):
4= Independent 3=Visual / Gestural 2=Verbal 1=Partial or Full Physical S=Step not completed by student
Steps of Routine / Date1. Walks off bus with belongings and enters correct door / 4321S / 4321S / 4321S / 4321
S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
S / 4321
S / 4321
S
2. Walks to correct locker / 4321
S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
S
3. Puts away belongings in locker / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
4. Pulls out items needed for class from backpack / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
5. Hold items needed for class in one hand/arm and closes locker with the other hand/arm / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
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6. Walks to correct class / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
7. Takes a seat and puts item on top of desk / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
Student Name: __Adriana___Martinez______Observer 1: __Mrs. Trimmins______
Class/Teacher: _____Mrs. Trimmins______Observer 2: ______IOA: ______
Routine: ______Navigating the hallway- classroom to bathroom______
KEY (definitions on back):
4=Independent 3=Visual / Gestural 2=Verbal 1=Partial or Full Physical S=Step not completed by student
Steps of Routine / Date1. Asks permission to go to the bathroom / 4321S / 4321S / 4321S / 4321
S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
S / 4321
S / 4321
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2. Once given permission, quietly gets up from seat and walks to the classroom door / 4321
S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
S
3. Turns in the direction towards to bathroom / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
4. Walks straight to the bathroom / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
5. Enters into the bathroom and completes bathroom routine / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
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6. Leaves bathroom and turns in direction towards the classroom / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
7. Walks straight to the classroom / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
8. Walks into classroom / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
9. Quietly walks to seat and sits down / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
Student Name: __Adriana___Martinez______Observer 1: __Mrs. Trimmins______
Class/Teacher: _____Mrs. Trimmins______Observer 2: ______IOA: ______
Routine: ______Completing a worksheet______
KEY (definitions on back):
4=Independent 3=Visual / Gestural 2=Verbal 1=Partial or Full Physical S=Step not completed by student
Steps of Routine / Date1. Walk to locker and grab lunch / 4321S / 4321S / 4321S / 4321
S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
S / 4321
S / 4321
S
2. Walk to lunchroom / 4321
S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
S
3. Walk to table and sit down / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
4. Open lunch bag / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
5. Remove items from lunch bag and place on table / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
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6. Open containers and eat food / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
7. Take drinks of beverage throughout meal / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
8. When finished (or told it is time to finish to), clean up / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
9. Walk to garbage can and throw away trash / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
10. Walk back to locker and put lunch inside / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
Student Name: __Adriana___Martinez______Observer 1: __Mrs. Trimmins______
Class/Teacher: _____Mrs. Trimmins______Observer 2: ______IOA: ______
Routine: ______Completing a worksheet______
KEY (definitions on back):
4=Independent 3=Visual / Gestural 2=Verbal 1=Partial or Full Physical S=Step not completed by student
Steps of Routine / Date1. Grab correct worksheet and walk to seat / 4321S / 4321S / 4321S / 4321
S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
S / 4321
S / 4321
S
2. Place worksheet on table / 4321
S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
S
3. Pull out pencil / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321
S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
4. Write name on worksheet in the designated spot / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
5. Read the instructions / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321
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6. If instructions are not clear or have difficulty reading instructions, raise hand to ask for help and asks for help / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
7. Follow instructions to complete worksheet / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
8. When needed, asks for help / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
9. When completed, take worksheet to designated spot for completed work. / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S / 4321S
Student Name: __Adriana___Martinez______Observer 1: __Mrs. Trimmins______
Class/Teacher: _____Mrs. Trimmins______Observer 2: ______IOA: ______
Routine: ______Following a visual schedule when making transitions______
KEY (definitions on back):
4=Independent 3=Visual / Gestural 2=Verbal 1=Partial or Full Physical S=Step not completed by student
Steps of Routine / Date