ER, Hospitalization and Urgent Care Entry Form

Please enter your full name.

For example, Adella House or New Lenox Woodworks

6. Individual's Level of Mobility
8. Gender
9. Type of Report
11. Day of the Week
12. Person Recommending the Visit
13. Was 911 used?
14. Was the physician notified prior to the visit?
15. When was the guardian notified?
16. Is there an Unusual Incident Report associated with this visit?
18. Is this the first visit for this problem?
22. Disposition from ER/Hospital
Please provide the following information in #25:

1. What led up to the event described above?

2. What was the exact issue that caused the event?

3. What was staff's immediate response to the event?

4a. What testing was done?

4b. What was the results of the testing?

5. What treatment was ordered as a result of the testing?

6. Is there any follow-up needed related to this event?

Please give a brief, specific description that includes all requested information (see instruction above).

Job Coach (Joliet,IL)


Location: Joliet, IL

Program or Services: Hempstead; Network 6

Schedule/Shift: Weekdays and weekends; with flexibility for some nights and weekends.

Description: Under the supervision of the Director of Employment Services, the Job Coach assists individuals who have been placed in various jobs within the community. A Job Coach works with the Job Developer to help to facilitate positive employment outcomes for individuals seeking employment, helping identify their skills and goals and working with them to continue learning and enhancing skills within the workplace. The supports and services provided will be done in a dignified, respectful and professional manner. 


  1. Promote a work environment that respects those we serve and always treats them with dignity and respect.
  2. Provide detailed feedback to Job Developers and Director on client progress in their day-to-day work activities and expectations.
  3. Assist clients with self-advocacy and self-esteem as they navigate the world of work.
  4. Document strengths and areas of need for clients as they are working.
  5. Coach clients on job retention techniques such as asking for their schedules, keeping track of time, increasing work pace, and building appropriate peer relationships.
  6. Maintain client progress notes and provide them to Job Developers in a timely and professional manner prior to each billing period.
  7. Be open to new experiences and techniques to assist clients to succeed at work.

Skills and Abilities:

  1. Ability to establish and maintain effective working relationships with program participants, coworkers, and their supervisor.
  2. Ability to communicate effectively orally and in writing.
  3. Ability to bend, lift and carry.
  4. Ability to follow written and oral instructions.

Minimum Qualifications:

  1. Experience preferably in Social Service, Psychology or a related field, or equivalent.
  2. Computer skills including Word, Excel, Email and Internet.
  3. A valid driver’s license is required.
  4. Maintain a current CPR and First Aid card.
  5. The physical activities for this position involve:  balancing, pulling, pushing, standing, climbing, grasping, stooping, crouching, crawling, kneeling, reaching, repetitive motion, and lifting up to 40 pounds.

Contact Information: Melissa Pierce,