Form Ddd-1403c - Individual Supported Employment Services Quality Assurance Review Page 5
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5DDD-1403C FORPDF (11-17)
Page 5 of 5
MEMBER FILES REVIEW
MEMBER’S NAME (Print)
DATE OF FILE REVIEW
YES
NO
N/A
COMMENTS
Are quarterly progress reports completed?
If Job Search was provided, is there a job search
agreement?
Do individual member ISP outcomes match the
outcomes in the quarterly progress reports?
If the job search did not result in employment, how were
the barriers to obtaining employment addressed?
Are there progress notes?
Are teaching strategies on file?
MEMBER FILES REVIEW
MEMBER’S NAME (Print)
DATE OF FILE REVIEW
YES
NO
N/A
COMMENTS
Are quarterly progress reports completed?
If Job Search was provided, is there a job search
agreement?
Do individual member ISP outcomes match the
outcomes in the quarterly progress reports?
If the job search did not result in employment, how were
the barriers to obtaining employment addressed?
Are there progress notes?
Are teaching strategies on file?
COMMENTS
ROUTING: Original – Employment Program Specialist, Copy – District File
Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with
Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Title II of the Genetic
Information Nondiscrimination Act (GINA) of 2008; the Department prohibits discrimination in admissions, programs, services, activities,
or employment based on race, color, religion, sex, national origin, age, disability, genetics and retaliation. To request this document
in alternative format or for further information about this policy, contact the Division of Developmental Disabilities ADA Coordinator at
602-542-0419; TTY/TDD Services: 7-1-1. • Free language assistance for DES services is available upon request. • Ayuda gratuita con
traducciones relacionadas con los servicios del DES esta disponible a solicitud del cliente.
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