Page 1 of 2 CLASSROOM OBSERVATION CHECKLIST FOR EDUCATIONAL by zaaaaa4

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CLASSROOM OBSERVATION CHECKLIST FOR EDUCATIONAL OCCUPATIONAL
                               THERAPY REFERRAL
Student Name: _________________________________________________________________
DOB: ______________Age: _________________Teacher: _____________________________
Date Filled: ____________________

                                     Areas of Concern    Description
 FINE MOTOR                           No       Yes
 Handwriting
 Cutting
 Dominance
 In Hand manipulation
 Keyboarding
 Bilateral skills
 Crossing Mid Line
 FUNCTIONAL SKILLS
 Oral motor skills
 Lunch time management
 Typing
 Toileting
 Fasteners
 Dressing
 Personal Hygiene
 Grooming
 PERCEPTUAL
 Copying skills
 Memory
 Attention Span
 Visual
 Auditory
 Sequencing
 Vision
  If distracted, do they re-direct
  independently?
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                                   Area of Concern   Description

GROSS MOTOR                          No     Yes
Balance
Strength
Safety
Stairs
Playground Equipment
Physical Education
Building mobility
Posture
ORGANIZATION
Transitions
Materials management
Sequencing
Neatness (self, desk, locker)
SOCIAL / BEHAVIORS
Activities avoided
Activities preferred
Self injurious behaviors
Self stimulating behaviors
Friends
Impulsiveness
Affect
Distractibility
Where does the student gravitate
to:
Gym
Playground
Lunch room

								
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