Effective Date: 



Updated: 1/2008


To obtain input from the person's perspective for the planning and development of Form 6609, Personal Support Plan.


When to Prepare

Worksheet accompanies the invitation letter or request for information letter sent six weeks before the scheduled PSP meeting. The completed form should be returned to the qualified intellectual disability professional (QIDP) no later than three weeks before the PSP meeting.


Person served, those chosen by the person served, home support staff and other Personal Support Team (PST) members complete the worksheet.

Responsible Party


Form Retention

QIDP files form.


Detailed Instructions


  • The person and/or the staff member who knows the person best should complete the entire worksheet as fully and accurately as possible.
  • The staff member who knows the person best should use the worksheet to interview the person served in his or her preferred language.
  • Team members and those chosen by the person complete only those items about which they are knowledgeable. Please denote items you are not knowledgeable about with N/A.

Describe what is important to the person in the following areas:

  • This section should reflect the person's preferences and what's important to him or her.
  • Use the person's words to reflect his or her perspective/view.
  • Include details, which are critical to understanding the person's preferences.
  • This information will be transferred to the PSP document to accurately reflect what's important to the person.
  • Write down everything, even if you do not agree, or if you think it is wrong, unsafe or unhealthy. It does not mean it will happen; however it will be discussed by the team.

Completed by: — Person served and/or staff who knows them best.

  • Person served should sign his or her name.
  • Staff member who knows the person best should sign name, title and date when completing or assisting the person.

Date — Date the form was completed.

Name/Title — All other staff, PST members, etc., should sign here when completing the form unless they assisted the person and signed above.

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