My Work Profile 1 Worksheet

 

Name:                                                                          

Date:                                                                                         

 

Directions: 

Circle or put a smiley face next to the sensory elements/environmental conditions that cause me to feel comfortable or relaxed.

Put an x over or put a sad face next to the sensory elements/environmental conditions that cause me to feel uncomfortable or tense.

Both instructor and participant are encouraged to add items to list

 

Crowds               Clutter                Bright lights       Dark                   Orderly/Neat    

 

Quiet                  Small spaces                    Big spaces                   Lots of activity/movement    

 

People talking nearby (not to me)            People talking to me or asking me questions

 

Sudden loud noises (horn honking, bells, alarms, cheering at sporting events, etc.)

 

Ongoing loud noises (machinery, large crowd, shouting, concert, beeping)    

 

Ambient noises (fans, machines, buzzing fluorescent lights, piped in music, etc.)

 

People noises (coughing, typing, clicking pen, music from their headphones, etc.) 

 

Cold                    Heat                   Being outdoors (temp, bugs, etc.)          Being indoors  

 

Bad weather (rain, thunder/lightening, cloudy, blazing sun, snow)

 

Hard seating      Soft seating        Tight clothes                   Loose clothes                   Wearing uniform    

 

Getting my hands dirty                Getting my clothes dirty               Sweating

 

Being up high (ladder, platform, etc.)      Being down low (on ground, crawling under things)

 

Moving Fast                     Moving slow                    Standing a lot                       Sitting a lot

 

Being around machines                Riding in a car                  Being watched                Being alone

 

Sitting close to another person (stranger – classroom, trolley, sporting event, etc.)       

 

Being bumped into (walking to class, student center at lunchtime, campus events, etc.)

 

Food smells - give/ask for examples both good & bad)                   

 

People smells (perfume, body odor, etc.) give/ask for examples both good & bad         

 

Chemical smells (cleaners, air freshener, gasoline pump)

 

Environmental smells (moldy, dusty, etc.)

 

Talking on the phone                   Talking in person              Looking someone in the eyes

 

Other: