Common Functional Limitations Checklist
WISCONSIN CLIENT ASSISTANCE PROGRAMCommon FunctionalLimitations ChecklistDesigned to facilitate discussion and identification oflimitations following a medical diagnosisCompiled by Reina Yano M.S.; C.R.C. with assistance from DebHenderson-Guenther M.S.; C.R.C.Adapted from the Disability Handbook by Aspen ProfessionalServicesTwo Thousand Seventeen Edition
WISCONSIN CLIENT ASSISTANCE PROGRAMExplanation of ReferencesThe vast majority of this work has been adapted from the Disability Handbook, Two ThousandSeventeen Edition (2017) by Andrew, J. D. & Andrew, M. J.This edition did not include functional limitations for visual impairments, so this author referred tothe Disability Handbook 2012 edition to create the Common Functional Limitations Checklist for thisdisability.For Anxiety Disorder, Deafness, Obesity and Sleep Disorder, this author utilized the referencematerials cited below in addition to the Disability Handbook 2017 edition.References Include:Andrew, J. D. & Andrew, M. J. (2017). Disability Handbook 2017 edition. Aspen Professional ServicesAndrew, J. D. & Andrew M. J. (2012). Disability Handbook 2012 edition. Aspen Professional ServicesAndrew, J. D. (2008) Disability Handbook 2008 edition.Job Accommodation Network. (2018). Accommodation and Compliance Series: Employees withHearing Loss. Retrieved from s.cfm?pubid 271050Job Accommodation Network. (2019). Accommodation and Compliance Series: Employees withSleep Disorders. Retrieved from s.cfm?pubid 965801Job Accommodation Network. (2021). Accommodation and Compliance Series: Employees withAnxiety Disorder. Retrieved from s.cfm?pubid 206299Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: Important considerations for public health.American Journal of Public Health, 100(6), 1019-1028. doi:10.2105/AJPH.2009.159491This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.i
WISCONSIN CLIENT ASSISTANCE PROGRAMTable of ContentsMovement Disorders. 37Albinism . 3Multiple Sclerosis . 38Allergies.4Obesity . 39Amputations . 5Pain . 40Anxiety Disorder . 6Complex Regional Pain Syndrome .41Arthritis. 7Personality Disorders . 42Asthma . 9Post-Polio Syndrome . 43Autism Spectrum Disorder . 10Post-Traumatic Stress Disorder . 44Bipolar Disorder . 11Renal-Kidney Disease . 45Cancer . 13Respiratory Disorders. 46Cardiovascular Disorders and PeripheralVascular Disease. 14Schizophrenic Disorder. 47Carpal Tunnel Syndrome . 15Sickle Cell Anemia . 49Cerebral Palsy . 16Sleep Disorders . 50Deafness . 19Spina Bifida . 51Delusional (Paranoid) Disorder . 21Spinal Cord Injury . 52Depression . 22Stroke . 54Diabetes Mellitus . 23Substance related and addictive disorders . 55Eating Disorders . 24Traumatic Brain Injury . 56Chronic Fatigue Syndrome . 25Visual Impairments . 58Seizure Disorder (Epilepsy) . 48Fibromyalgia . 26Hard of hearing . 27Hemophilia . 28H.I.V. (AIDS) . 29Intellectual Disabilities . 30Learning Disorders . 31Chronic Lower Back Pain. 33Mania . 34Motor Neuron Diseases . 35Movement Disorders . 36This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.ii
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated withAlbinismCommon Functional LimitationsYes, No, or Don’tKnow in My CaseJudgment fromothers over appearanceYND/KIssues with employer and peeracceptanceYND/KIssues with self-conceptYND/KDelay in social skillsdevelopmentYND/KDo you have photosensitivity?Do you have to take precautionsbefore going outside?YND/KDoes your disability cause youto have problems with:-reading,writing, driving, space/form/depth perception, field of visiondeficit, sensitivity to glare(photophobia)YND/KBleeding tendencies- related toHermansky-Pudlak Syndrome(HPS)YND/KBreathing conditions related toHPSYND/KBowel conditionsYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.3
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated withAllergiesCommon Functional LimitationsYes, No, or Don’tKnow in My CaseDifficulty to work outside due toallergensYND/KDifficulty working in wet, humidconditionsYND/KDifficulty working near fumesand dustYND/KLimited ssYND/KProblems with motorcoordinationYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.4
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated withAmputationsCommon Functional LimitationsYes, No, or Don’tKnow in My CaseHow will itemsmarked YES be addressed?Upper ted bimanual YND/KStoopingYND/KPushingYND/KPullingYND/KCarrying large objectsYND/KLifting heavy or bulky objectsYND/KIntolerant of sudden jarring ortrauma to amputated limbYND/KIntolerant of environmentalconditions (heat, cold, humidity,dirt) with prosthesis wearersYND/KLower Extremity:Upper or Lower Extremity:This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.5
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated withAnxiety Disorder1Common Functional LimitationsYes, No, or Don’tKnow in My CaseStress intoleranceYND/KDeficits in attentiveness andconcentrationYND/KMemory problems/memory lossYND/KDifficulty with planning,organizing, prioritizingYND/KDifficulty with time managementYND/KChallenges commuting to andfrom workYND/KIssues with communication withcoworkersYND/KInconsistent attendance(avoidance of fearful situations)YND/KDecreased work staminaYND/KFocus on physical ailmentsYND/KDifficulty meeting deadlines/multi-taskingYND/KHow will itemsmarked YES be addressed?1Job Accommodation Network (2021) Accommodation and Compliance Series: Employees withAnxiety DisorderThis information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.6
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated withArthritisCommon Functional LimitationsYes, No, or Don’tKnow in My CaseHow will itemsmarked YES be addressed?Upper Extremities:Fine hand movementsYND/KFingeringYND/KStiffness in joints; affects dexterityYND/KGraspingYND/KWorking above the shouldersYND/KLack tactile ND/KStandingYND/KLower Extremities (including back):This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.7
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated withArthritisCommon Functional LimitationsYes, No, or Don’tKnow in My CaseHow will itemsmarked YES be addressed?Either Upper or Lower Extremities:Movement affected by extremes ofweather/ temperature conditionsYND/KIntolerant of strenuous activitieswithout taking frequent rest periodsYND/KIntolerant of trauma/ jarring/ overuseof affected jointsYND/KPainYND/KLimited mobilityYND/KLimited range of motionYND/KThis information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.8
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:AsthmaCommon Functional LimitationsYes, No, or Don’tKnow in My CaseWalkingYND/KClimbingYND/KLiftingYND/KLimited staminaYND/KSensitivity to coldYND/KProblems managingtemperature changesYND/KDifficulty being in wet, humidconditionsYND/KProblems working near fumesand dustYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.9
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:Autism Spectrum DisorderCommon Functional LimitationsYes, No, or Don’tKnow in My CaseDifficulty in learning languageYND/KProblems with verbal andnonverbal communicationYND/KImpaired social interactionYND/KInappropriate response topeople (e.g. avoiding eyecontact or seeming tuned out)YND/KExtreme resistance to changeYND/KHyperactivity or unusualpassivityYND/KRepetitive or severely limitedactivities and interestsYND/KRepetitive body movements (e.g.pacing, hand flicking, twisting,spinning, rocking or hittingoneself)YND/KUnusual attachment toinanimate objectsYND/KUnusual responses to light,sound, touch, smell, taste,movementYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.10
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with Affective Disorder:Bipolar DisorderCommon Functional LimitationsYes, No, or Don’tKnow in My CaseIssues with interpersonal skills(cooperation, tact, and empathy)YND/KIssues with dependabilityYND/KProblems with decision-makingYND/KDealing with frequent changeYND/KLimited stamina(fatigue and lethargy)YND/KIssues with judgmentYND/KIssues with motivation orinitiativeYND/KIssues with follow-through orability to follow instructionsYND/KIssues withself-confidence/self-imageYND/KDrowsiness from interruptedsleep patterns or lack of sleepYND/KIssues with concentrationYND/KMemory problemsYND/KIssues with stability;consistency of behaviorYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.11
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:BurnsCommon Functional LimitationsYes, No, or Don’tKnow in My CaseIntolerance to extreme heatconditionsYND/KJudgment from others overappearanceYND/KFear of meeting the publicYND/KAvoidance of activities causingtrauma/ irritation to injured skinand/or jointsYND/KLimited range-of-motion if jointsare affectedYND/KIssues with self-imageYND/KIssues with employer/ peeracceptanceYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.12
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:CancerCommon Functional LimitationsYes, No, or Don’tKnow in My CaseLimited staminaYND/KDecreased strengthYND/KLifting abilityYND/KClimbing abilityYND/KWalking enduranceYND/KIntolerance to ulty breathingYND/KNauseaYND/KDiarrhea or constipationYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.13
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:Cardiovascular Disorders and Peripheral Vascular DiseaseCommon Functional LimitationsYes, No, or Don’tKnow in My CaseMobility (walking, running,climbing stairs)YND/KStanding for prolonged periods(*Has physician contraindicatedstanding?)YND/KLifting, pushing, pulling,reaching, pressing (*Are anyback problems present?)YND/KLimited stamina and/orenduranceYND/KDifficulty managing temperatureextremesYND/KDizziness (*If yes, under whatconditions?)YND/KIntolerance to environmentalchanges (gases, fumes, airquality, altitude changes)YND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.14
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:Carpal Tunnel SyndromeCommon Functional LimitationsYes, No, or Don’tKnow in My eYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.15
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:Cerebral PalsyCommon Functional LimitationsYes, No, or Don’tKnow in My CaseHow will itemsmarked YES be addressed?Physical Limitations:Limited staminaYND/KPushing, pulling, pressingYND/KMuscular control, coordinationbalance, speedYND/KAmbulation, standing, stooping,bending, climbingYND/KWriting, drivingYND/KBowel and bladder, pulmonary,painYND/KDifficulty performing daily livingactivities (eating, cooking,dressing, personal hygiene)independentlyYND/KHearing disordersYND/KAuditory and visualcomprehension disordersYND/KIssues with distractibilityYND/KSpeech affectedYND/KLanguage and communication:This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.16
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:Cerebral PalsyCommon Functional LimitationsYes, No, or Don’tKnow in My CaseHow will itemsmarked YES be addressed?Psychosocial limitations:Cognition (verbal perception,reception or expression, visualperception, visual motor)YND/KProblems with memoryYND/KProblems with schoolachievementYND/KAcquisition retention,interpretation and applicationof informationYND/KIssues with social isolationYND/KProblems with dependency andself-centerednessYND/KLack of initiation in takingresponsibilityYND/KContractures (joint limitations)YND/KBowel and bladder incontinenceYND/KDental problemsYND/KOsteoporosisYND/KDegenerative joint disordersYND/KScoliosisYND/KRespiratory infections due toinefficient swallowing andcompromised cough complexYND/KComplications:This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.17
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:Cerebral PalsyCommon Functional LimitationsYes, No, or Don’tKnow in My CaseHow will itemsmarked YES be addressed?Other Commonly associated problems or disabilities:Learning disabilities(visual/auditory processing)YND/KIntellectual disabilitiesYND/KVisual and/or hearing problemsYND/KProblems developingindependent living skillsYND/KSeizuresYND/KFatigueYND/KLimited problem-solving skillsYND/KThis information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.18
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:Deafness2Common Functional LimitationsYes, No, or Don’tKnow in My CaseSense of isolationYND/KLack of incidental learningYND/KEnglish as a second language/underdeveloped primarylanguageYND/KMinimal awareness of hearingnormsYND/KDifficulty communicating faceto-faceYND/KDifficulty understanding verbalinstructionsYND/KCommunicating in groups,meetings, or trainingsYND/KDifficulty responding to soundsin the environmentYND/KDifficulty interpreting bodylanguage or facial expressionYND/KIssues with self-imageYND/KSpeech clarityYND/KBalance/motor coordinationYND/KDeficits in school achievementYND/KProblems in conceptualizationYND/KHow will itemsmarked YES be addressed?2Job Accommodation Network (2018) Accommodation and Compliance Series: Employeeswith Hearing LossThis information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.19
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:DeafnessCommon Functional LimitationsYes, No, or Don’tKnow in My CaseTendency to take things in veryconcrete waysYND/KOthers misjudging your skillsand abilitiesYND/KSafely operating or workingaround vehiclesYND/KMay have difficulty wearinghearing protectionYND/KDifficulty communicatingthrough landline phone serviceYND/KSusceptibility to depression,alcoholism, drug addiction, etc.YND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.20
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:Delusional (Paranoid) DisorderCommon Functional LimitationsYes, No, or Don’tKnow in My CaseIssues with dependabilityYND/KProblems conforming to rulesYND/KIssues with judgmentYND/KDifficulty with logical thinkingYND/KIssues with cooperationYND/KProblems with tactYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.21
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with Affective Disorders:DepressionCommon Functional LimitationsYes, No, or Don’tKnow in My CaseDepressed mood;difficulty moderating moodYND/KInability to enjoy usual activitiesYND/KPsychomotor problems(slowness in speech, thought,and movement)YND/KProblems with decision makingYND/KLimited stamina(fatigue and lethargy)YND/KDifficulty with follow-through orfollowing instructionsYND/KIssues with judgmentYND/KIssues with motivation orinitiativeYND/KBodily complaints: headaches,back pain, muscle cramps,nausea, etc.YND/KIssues withself-confidence/ self-imageYND/KDrowsiness from interruptedsleep patterns or lack of sleepYND/KIssues withconcentration/loss of interestYND/KMemory problemsYND/KIssues with stability;consistency of behaviorYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.22
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:Diabetes MellitusCommon Functional LimitationsYes, No, or Don’tKnow in My CasePhysical stamina and/orenduranceYND/KStandingYND/KWalkingYND/KMotor coordinationYND/KHeavy exertionYND/KTactile discrimination (being ableto feel objects with your fingers)YND/KFinger dexterityYND/KHandlingYND/KGraspingYND/KManual dexterityYND/KTolerance to extremes intemperatureYND/KTolerance to long hours withoutrest/food intakeYND/KTolerance to occupations thatpose unusual injury hazards(cuts, burns, skin injuries)YND/KProblems with concentrationYND/KVisual acuityYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.23
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:Eating DisordersCommon Functional LimitationsYes, No, or Don’tKnow in My CaseLimited staminaYND/KStrengthYND/KCold intoleranceYND/KIssues with decisions/judgment(persons experiencing bulimiaare frequently associated withimpulsive behavior such asalcohol/drug abuse,stealing/shoplifting and suicidalbehavior)YND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.24
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:Chronic Fatigue SyndromeCommon Functional LimitationsYes, No, or Don’tKnow in My CaseOverwhelming fatigue thatcompletely destroys one’senergy and strengthYND/KCognitive problems, lack ofconcentration or mental malaise(brain fog)YND/KSleep disorder, wakefulness,unable to go back to sleepYND/KPersistent muscle discomfortand migratory joint painYND/KNagging scratchy and sorethroatYND/KEnlarged lymph nodes in theneck or armpits that are tenderand painfulYND/KMild to severe headaches,nauseaYND/KDepression and anxietyYND/KSide effects and/or reactions tomedicationsYND/KMuscle atrophy due to lack ofactivityYND/KSocial isolation caused byfatigueYND/KLifestyle restrictionsYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.25
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:FibromyalgiaCommon Functional LimitationsYes, No, or Don’tKnow in My CaseConstant pain, ranging from adull ache to severe anddebilitatingYND/KFatigue frequently resulting frominsomnia or sleep disturbancessuch as apneaYND/KLack of concentration or mentalmalaise (brain fog)YND/KFrequent need to use restroomcaused by Irritable BowelSyndromeYND/KRecurrent tension-typeheadaches and migraines thatcan be accompanied by nausea,vomiting, extreme sensitivity tolight and noiseYND/KDepression and mood swingsYND/KLow self-esteemYND/KSensitivity to changes intemperature, bright lights,odors, and loud soundsYND/KPainful period and premenstrualdiscomfortYND/KNumbness and tingling in theextremitiesYND/KDizzinessYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.26
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:Hard of hearingCommon Functional LimitationsSense of isolationYes, No, or Don’tKnow in My CaseYND/KRejection and withdrawalYND/KDifficulty communicating faceto-faceYND/KDifficulty understanding verbalinstructionsYND/KCommunicating in groups,meetings, or trainingsYND/KResponding to sounds inenvironmentsYND/KDifficulty with appropriateconversational normsYND/KDifficulty with communicating innoisy environmentsYND/KDiscriminating soundsYND/KSpeech clarityYND/KPossible low self-imageYND/KIncreased risk of complication(e.g. depression or alcoholism)YND/KOthers misjudging skills andabilitiesYND/KDifficulty communicatingthrough landline phone serviceYND/KHow will itemsmarked YES be addressed?English as a second language/underdeveloped primarylanguageThis information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.27
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:HemophiliaCommon Functional LimitationsYes, No, or Don’tKnow in My CaseClimbingYND/KStooping, kneeling, crouchingYND/KLiftingYND/KStrengthYND/KUnable to work in physicallyhazardous work settingsYND/KLimited range of motionYND/KChronic painYND/KFear of injury that might causebleedingYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.28
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:H.I.V. (AIDS)Common Functional LimitationsYes, No, or Don’tKnow in My CaseIssues with dependabilityYND/KDifficulty making decisionsYND/KDifficulty with frequent changeYND/KLimited staminaYND/KIssues with strengthYND/KSensitivity to temperaturechangesYND/KProblems with depressionYND/KFeeling fearfulYND/KFeeling isolatedYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.29
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:Intellectual DisabilitiesCommon Functional LimitationsYes, No, or Don’tKnow in My CaseLearning work skillsYND/KProblems with self-directionYND/KProblems communicatingYND/KInterpersonal skillsYND/KLimited work toleranceYND/KMobilityYND/KSelf-care issuesYND/KTransportation (the ability todrive a motor vehicle or makeuse of public transportation)YND/KChallenges with reading, writing,spellingYND/KProblems with math calculationsYND/KAuditory/ visual memorydifficultiesYND/KProblems with form and spatialperceptionYND/KIssues with concentrationYND/KVisual motor problemsYND/KIssues with abstract thinkingYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.30
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:Learning DisordersCommon Functional LimitationsYes, No, or Don’tKnow in My CaseDifficulty with organizing workYND/KTime management problemsYND/KConceptualization problemsYND/KDecision making problemsYND/KIssues with maturityYND/KChallenges with reading, writing,and spellingYND/KProblems with math calculationsYND/KAuditory/ visual memorydifficultiesYND/KProblems with form and spatialperceptionYND/KIssues with concentrationYND/KIssues with attending to a taskYND/KVisual motor problemsYND/KIssues with abstract thinkingYND/KProblems following instructionsYND/KProblems with self-imageYND/KInterpersonal relationsYND/KImpulse control problemsYND/KUnclear/ vague communicationstyleYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.31
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:Learning DisordersCommon Functional LimitationsYes, No, or Don’tKnow in My CaseInability to focus on detailsYND/KSequencing problemsYND/KRelational distortionsYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.32
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with:Chronic Lower Back PainCommon Functional LimitationsYes, No, or Don’tKnow in My ND/KLiftingYND/KClimbingYND/KCarryingYND/KLimited staminaYND/KPainYND/KActivities in daily living (severecases)YND/KAdditional limitations due toside effects of medicationsYND/KUnable to drive a vehicle forlong periodsYND/KHow will itemsmarked YES be addressed?This information is funded byRehabilitation Services Administration WI Client Assistance Program grant H16A040054.33
WISCONSIN CLIENT ASSISTANCE PROGRAMReturn to Table of ContentsCommon Functional Limitations Checklist Associated with Affective Disorders:ManiaCommon Functional LimitationsYes, No, or Don’tKnow in My CaseIssues with interpersonal skills(cooperation, tact, and empathy)YND/KIssues with dependabilityYND/KProblems with decision-makingYND/KIssues with judgmentYND/KDifficulty managing moneyYND/KFlight of ideas;difficulty organizing thoughtsYND/KIssues with motivation orinitiativeYND/KIssues with follow-through orability to follow instructionsYND/KDrowsiness from interruptedsleep patterns or lack of sleepYND/KIssues with concentratio
Common Functional Limitations Checklist Associated with Allergies Common Functional Limitations Yes, No, or Don’t Know in My Case How will items marked YES be addressed? Difficulty to work outside due to allergens Y N D/K Difficulty working in wet, humid conditio
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Chemistry and Toxicology Checklist 07.11.2011 INTRODUCTION This Checklist is intended for comprehensive clinical chemistry testing, including blood gas analysis and toxicology. An inspection of a laboratory section, or department will include the discipline-specific checklist(s), the Laboratory General Checklist, and the All Common Checklist (COM).
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That necessitated a revision of the audit checklist. The attached audit checklist replaces the checklist developed in May 1992. The checklist covers all the evaluation components of the previous checklist, but it also looks at other areas including a program's environmental effectiveness and its use of pollution-prevention measures. PURPOSE
Checklist für Diamond DA40 NG . Edition #: 17.3 Edition date: 15.04.2017. Please observe: The file you are receiving hereby combines all three sections of the checklist: Normal Checklist, Emergency Checklist and Abnormal Checklist. All pages of a new edition will have the same new "edition #" and "edition date", even if
Checklist für Diamond DA40 TDI G1000 . Edition #: 17.1 Edition date: 15.04.2017. Please observe: The file you are receiving hereby combines all three sections of the checklist: Normal Checklist, Emergency Checklist and Abnormal Checklist. All pages of a new edition will have the same new "edition #" and "edition date", even if
the West Virginia Supreme Court has made no ruling as to when the statute of limitations begins to run (Noland, 686 S.E.2d at 40). NEGLIGENCE 13. What is the statute of limitations for a negligence claim in your jurisdiction? LIMITATIONS PERIOD The statute of limitations is two years (W. Va. Code § 55-2-12;
List of Plates Plate 1 Tea break! 4 Plate 2 Outline of robbed out wall visible in Trench 2c. Taken from the N. 8 Plate 3 W facing fireplace [2055], during excavation. Taken from the SW. 9 Plate 4 General view of fire place and rake out area following excavation, Trench 2c. Taken from the SW. 9 Plate 5 Stake [2091], set into natural sand (2072). Taken from the N 10
