ESS-C-353-9 ESS Assessment Summary (Rev. 2022-03-09)

Form Number: 


This form is for the ESS-C-353-9 Contract Assessment Milestone. EC will use this form to document the assessments performed, and the date and time spent on the assessments. If using an assessment not listed on the form, list it in the Other category. The second page of the form is the Assessment Narrative used to document the summary of the areas identified in the assessments and through observation which require additional training and supports to assist the individual with increased independence, community engagement, and employability. The EC will submit to the DRS Counselor the ESS-C-353-9, any assessments conducted, and the other required documentation for payment.


File Origination or Revision Date: 

Revised 2022-03-09