One-To-One Program/Individual Job Assignment Plan

This form has been designed as an instruction sheet to aid in the communication process and documentation of one-to-one program plans and individualized resident work/service plans. The form provides for description of the type of plan; also ensures that the person providing assistance (one-to-one) or the resident (job assignment) understands exactly what is to be done, how it is to be done, what the desired outcome is and how to document the outcomes.

This updated form provides the following required information:

• If the work/job is paid or voluntary
• A statement that the resident can refuse to work or provide services at any time
• Date work/service plan started and
• Prompt to ensure that the resident s Care Plan is reflective of work/services as well as payment\

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