Client's name:
The following assessment form will help you and the client to clarify if education will benefit him/her.
1. Understanding his/her job
1A. What job duty of his/her job did he like the most?
1B. Did he/she like the job or the people he/she worked with most?
yes /
no.
1C. Did he/she think his/her employer was fair to him/her?
yes /
no.
1D. Did he/she think that the job was a good part of his/her life?
yes /
no.
1E. Did he/she receive recognition and pay raises for work done?
yes /
no.
1F. What skills and strengths does he/she have from working on this job?
1G. What liabilities does he have for doing his former job?
1H. What did he not do well in his job?
2. Alternatives in his/her workplace
2A. Is there an alternative job in his/her workplace that he could do that would not require further education or training?
yes /
no.
2B. What has the employer said about accepting him/her to return to work with limitations?
2C. Are there other employees who have returned to work after an injury?
yes /
no.
2D. What are the written guidelines for returning an injured worker back to work?
3. Alternatives to working at his former job
3A. What special or detailed knowledge does the client have in some other field?
3B. What way does the client know of that he can be employed using this knowledge and with his present physical limitations?
3C. What contacts does he have with people in other jobs that might help him get a new job in the other field?
4. Considerations for short or long-term training
4A. Did he/she like school?
yes /
no.
4B. What subjects did he/she enjoy most of all?
4C. What other training would the client consider in a school or on-the-job?
4D. What new skill does he think that he could learn for a new job?
Now you can click on the "Send" button below, Then you can copy-and-paste this information from your email program into your client's computer file. Or you can go to the top of this form and print it, then file the paper copy.