Person Centered Employment Plan Form Page 19
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29Section 5 - Action Steps Completed
List the employers or agencies you contacted, the date of contact, and the outcome of your
contact.
1. Date of Contact: ____________Method of Contact: (phone, in person, mail)_______________
Employer: ____________________________________________________________________
Contact Made By: ______________________________________________________________
Outcome of Contact: ___________________________________________________________
2. Date of Contact: ____________Method of Contact: (phone, in person, mail)_______________
Employer: ____________________________________________________________________
Contact Made By: ______________________________________________________________
Outcome of Contact: ___________________________________________________________
3. Date of Contact: ____________Method of Contact: (phone, in person, mail)_______________
Employer: ____________________________________________________________________
Contact Made By: ______________________________________________________________
Outcome of Contact: ___________________________________________________________
Other Action Steps Completed:
1. Action:_______________________________________________________________________
Date: _____________________Who Completed Action: _______________________________
Outcome of Action: ____________________________________________________________
_____________________________________________________________________________
2. Action:_______________________________________________________________________
Date: _____________________Who Completed Action: _______________________________
Outcome of Action: ____________________________________________________________
_____________________________________________________________________________
3. Action:_______________________________________________________________________
Date: _____________________Who Completed Action: _______________________________
Outcome of Action: ____________________________________________________________
_____________________________________________________________________________
19
Person Centered Employment Plan
REV 6/2014
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