Forms for Developmental Disabilities Services

Forms Related to COVID-19

Individual Support Agreement (ISA) COVID-19 Change Form

Payment Authorization Form, COVID-19

Return to Community Activities Assessment Tool

Return to Employment Services Assessment Tool

 

Below are some frequently used forms for developmental disabilities services.  Additional forms can be found in policies or guideline documents that are in the Document Library.

Application Form

Accessibility Standards and Checklist (Pre-Inspection form)

Chimney Cleaning and Inspection by Non-Professional form

Critical Incident Reporting Form

DAIL Risk Assessment Face Sheet

DAIL Risk Assessment Other Behavior Worksheet

DAIL Risk Assessment Sexual Behavior Worksheet

DAIL Risk Assessment Violent Behavior Worksheet

DAIL Risk Assessment Violent Behavior Static Information

Equity/Public Safety Funding Form (Spreadsheet)

Equity/Public Safety Funding Proposal Request

Eligibility Form, DD Home and Community-Based Services (HCBS)

Emergency Fact Sheet

Home Safety Assessment Request for Housing Contractor

Housing Standards and Checklist (Pre-Inspection form)

Living Out-of-State Report Form for DD Home and Community-Based Services (HCBS)

Notification of Transfer/Termination Form for DD Home and Community-Based Services (HCBS)

Sex Offender Treatment Intervention and Progress Scale (SOTIPS) Score Sheet

Vermont Crisis Intervention Network (VCIN) Referral Form

Violent Offender Treatment Intervention and Progress Scale (VOTIPS) Score Sheet