Name _________________________           Time ________________                     

Date ________________        Therapist name: ____________________________

 

Start Time

End Time

Tasks

 

 

Take apart wooden box

 

 

Assemble large pipe tree by following diagram.

Show therapist how you did.

Take apart, start on second diagram.

 

 

Follow printed directions for setting up BTE.

Teach another person to run the machine.

 

 

Put wooden box back together

 

 

Finish anything that you didn’t get done