New Jersey Department of Human Services. Division of Developmental Disabilities www.nj.gov/humanservices/ddd Community Based / Individual Supports(Not applicable when delivering daily rate version of Individual Supports. Only used for 15 minute unit version) Employee's Name *Individual's Name *Service Plan Year *ISP Outcome *Service Strategies (Check all that apply) *Assistance with Activities of Daily Living (such as getting dressed, eating, personal hygiene, etc.)Assistance with Increasing Community Participation (such as daily errands, attending events, restaurant, purchasing items, travel training, etc.)Assistance with Increasing Independence (such as helping the individual learn to do laundry, cook, clean, dress, grocery shop, pay for items, etc.)Assistance with On-The-Job Support (such as safety awareness, using the restroom, attending to task, lunch/breaks, etc.)Assistance with Learning Activities (such as basic tutoring – math, reading, writing; support in attending a class; etc.)Date *Start Time *End Time *Individualized Activity *Tell us about the day, and how the activities will help the individual reach the above outcome *Total Hours Worked *Completed By *Signature *Start signing your signature hereYour browser does not support e-Signature field.Submit