Form DR384A "Supported Employment - Proposed Plan to Improve Performance" - California

What Is Form DR384A?

This is a legal form that was released by the California Department of Rehabilitation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2008;
  • The latest edition provided by the California Department of Rehabilitation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DR384A by clicking the link below or browse more documents and templates provided by the California Department of Rehabilitation.

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Download Form DR384A "Supported Employment - Proposed Plan to Improve Performance" - California

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STATE OF CALIFORNIA
DEPARTMENT OF REHABILITATION
SUPPORTED EMPLOYMENT - PROPOSED PLAN TO IMPROVE PERFORMANCE
Attachment to DR384 Supported Employment - Monthly Job Coach Report
DR384A (Rev 02/08)
Page 1 of 2
Consumer:
Job Coach:
DOR Counselor:
Report Month/Year:
Check the performance areas below that were indicated as unsatisfactory on the DR384, page 1 of 2. For each area
checked to indicate unsatisfactory performance, address the interventions proposed to improve performance including
timeframes and recommendations for other services as required.
Work Habits
Attendance / Punctuality (Interventions & Timeframes):
Following Procedures (Interventions & Timeframes):
Cooperation (Interventions & Timeframes):
Taking Initiative (Interventions & Timeframes):
Grooming / Hygiene (Interventions & Timeframes):
Work Performance
Understanding of Job Tasks (Interventions & Timeframes):
Accuracy / Quality (Interventions & Timeframes):
Work Pace (Interventions & Timeframes):
Focus / Concentration (Interventions & Timeframes):
Passing Probation (Interventions & Timeframes including Probation Date):
STATE OF CALIFORNIA
DEPARTMENT OF REHABILITATION
SUPPORTED EMPLOYMENT - PROPOSED PLAN TO IMPROVE PERFORMANCE
Attachment to DR384 Supported Employment - Monthly Job Coach Report
DR384A (Rev 02/08)
Page 1 of 2
Consumer:
Job Coach:
DOR Counselor:
Report Month/Year:
Check the performance areas below that were indicated as unsatisfactory on the DR384, page 1 of 2. For each area
checked to indicate unsatisfactory performance, address the interventions proposed to improve performance including
timeframes and recommendations for other services as required.
Work Habits
Attendance / Punctuality (Interventions & Timeframes):
Following Procedures (Interventions & Timeframes):
Cooperation (Interventions & Timeframes):
Taking Initiative (Interventions & Timeframes):
Grooming / Hygiene (Interventions & Timeframes):
Work Performance
Understanding of Job Tasks (Interventions & Timeframes):
Accuracy / Quality (Interventions & Timeframes):
Work Pace (Interventions & Timeframes):
Focus / Concentration (Interventions & Timeframes):
Passing Probation (Interventions & Timeframes including Probation Date):
STATE OF CALIFORNIA
DEPARTMENT OF REHABILITATION
SUPPORTED EMPLOYMENT - PROPOSED PLAN TO IMPROVE PERFORMANCE
Attachment to DR384 Supported Employment - Monthly Job Coach Report
DR384A (Rev 02/08)
Page 2 of 2
Consumer:
Report Month/Year:
Interpersonal Skills
Supervisor (Interventions & Timeframes):
Co-workers (Interventions & Timeframes):
Customer / Public (Interventions & Timeframes):
Job Coach (Interventions & Timeframes):
Distribution:
DOR Counselor (via email or fax, see DR381)
DOR District Office (with Invoice)
Regional Center Service Coordinator (via email / fax when percentage of intervention is 30% or less)
NOTICE: This is confidential information from the records of the California Department of Rehabilitation. State and federal law and
departmental regulations prohibit you from making any further disclosure of this information without the informed, written consent of the
person to whom this information pertains.
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