IPS Details


Client Details


Some people’s conditions affect their ability to do certain day to day tasks in their lives. To rate your problems look at each section and determine on the scale provided how much your barriers impairs your ability to carry out the activity, with 1 being not at all and 8 being very severely.

Employment Contacts (if applicable)

Name Position Contact Details

Availability of customer/line manager/Access to Work Adviser/other key contacts in the next eight working days.

Days MON TUE WED THUR FRI
HRS
Days MON TUE WED THUR FRI
HRS
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