Effective Date: 
9/2007

Documents

Instructions

Updated: 9/2007

Purpose

Personal Support Teams (PSTs) use these tools to identify significant risks in the person's life and to design the necessary supports to minimize those risks.

Procedure

When to Prepare

Complete annually in preparation for the Personal Support Plan (PSP) meeting or as significant changes occur via Form 6624, Personal Support Plan Addendum.

Who Completes Forms

  • Habilitation or medical staff, as determined by the facility, complete this form and Form 6606-B, Risk Screening Tool – Aspiration/Choking, Dehydration.
  • Psychology staff complete Form 6606-C, Risk Screening Tool – Behavior.
  • Other disciplines may be required for consultation.

Participants

Qualified intellectual disability professional (QIDP), home supervisor, psychology staff, medical/nursing staff, person, staff who know the person best, legally authorized representative (LAR)/family and other disciplines as appropriate.

Form Retention

Retain this form in the QIDP file for three years.

Detailed Instructions

  • The designated staff complete the assigned section as follows:
    • Review each significant risk issue to determine whether or not it poses a significant risk of harm to the person. Consultation with other disciplines may be required to determine whether or not a significant risk should be identified.
    • If a significant risk is identified, check the Yes box and make any relevant comments.
    • If a significant risk is identified that is not listed, use the blank spaces provided in the General/Other Risk considerations section to document that risk. This may be written as a statement/concern rather than a question.
  • Return the completed section to the QIDP no later than three weeks before the scheduled PSP meeting.
  • The QIDP compiles all sections of the Risk Screening Tools, completes Form 6612, Risk Tracking Record (RTR), and submits the RTR for the team to review no later than one week before the PSP meeting.

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