Form Ddd-1401c - Center Based Employment - Quality Assurance Review Page 5
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6DDD-1401CFORFF (6-17) Page 5 of 6
WORKSITE OBSERVATION
SITE NAME
SITE LOCATION
DESCRIBE THE PAID WORK THE MEMBERS WERE PERFORMING.
DESCRIBE THE ALTERNATIVE ACTIVITIES MEMBERS WERE PERFORMING.
WHAT WAS DIRECT SUPPORT STAFF DOING DURING THE VISIT?
WHAT WAS THE STAFF TO MEMBER RATIO DURING THE VISIT?
POSITIVE OBSERVATIONS:
Staff/member interactions:
Physical site:
Other:
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Parent category: Legal