1
Classroom
Observations
Student:________________________________ Date and time: __________________
School:__________________________ Teacher: _____________________________
Aide present: Y or N Activity description: __________________________________
Impacts
Performance
Observations:
Response to Environment
YES
NO
Does not look at the person
speaking
Difficulty following verbal
directions
Difficulty following visual
demonstrations
Distracted by visual stimuli
Distracted by auditory
stimulation
Excessive movement
Makes noises to self
Student at Desk
Position in the room
Desk height
Seated body position
Organization of materials
Fidgets when seated
Slumps or leans on desk
2
Impacts
Performance
Observations:
Student Performance
YES
NO
Level of attention to task
Level of independence
Cueing needed from the
teacher
Difficulty transitioning
Difficulty following multistep
directions
Difficulty managing
classroom tools
Difficulty with organization
Poor social interactions
Work samples reviewed: