Name _________________________           Time ________________                     

Date ________________        Therapist name: ____________________________
                           

 

Start Time

End Time

Tasks

 

 

Place 4 envelopes in proper places in therapy gym

by following directions on paper

 

 

Assemble large pipe tree

 

 

Pick up envelope B

 

 

Word problems

 

 

Pick up envelopes A,D

 

 

Put grocery items on shelf by following list

 

 

Pick up remaining envelope

 

 

Finish anything that you didn’t get done