Form Ddd-1402c - Group Supported Employment - Quality Assurance Review Page 5
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8ARIZONA DEPARTMENT OF ECONOMIC SECURITY
DDD-1402CFORFF (6-17) Page 5
Division of Developmental Disabilities (DDD)
Group Supported Employment - QUALITY ASSURANCE REVIEW
MEMBER FILES REVIEW (Continued)
MEMBER’S NAME (Print)
DATE OF FILE REVIEW
YES
NO
N/A
COMMENTS
Are monthly progress reports completed?
Are individual time studies completed?
Is there a current individual Support Plan and
an employment outcome/objective?
Do Individual Member ISP outcomes match
the outcomes in the quarterly progress reports
Are there progress notes?
Is there a medical emergency contact on file?
MEMBER’S NAME (Print)
DATE OF FILE REVIEW
YES
NO
N/A
COMMENTS
Are monthly progress reports completed?
Are individual time studies completed?
Is there a current individual Support Plan and
an employment outcome/objective?
Do Individual Member ISP outcomes match
the outcomes in the quarterly progress reports
Are there progress notes?
Is there a medical emergency contact on file?
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