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Forms for Developmental Disabilities Services

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

Communication Forms
Communication Dictionary
Communication Plan Form
Communication Planning Checklist
Communication Technical Information Form

COVID-19 Forms
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

Critical Incident Reporting Form

DAIL Risk Assessment Forms
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 Forms/Public Safety Forms
Eligibility Form, DD Home and Community-Based Services (HCBS)
Emergency Fact Sheet
Equity/Public Safety Funding Form (Spreadsheet) (Word-fillable)
Equity/Public Safety Funding Proposal Request
Equity/Public Safety Request for Funding form

Group Home Referral Form

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