|
Directions: For each item, place a check in the appropriate column
|
Rarely |
Sometimes |
Always |
|
Communication: |
|
|
|
| 1. |
Follows two step related directions (Hang up your coat and bag) |
|
|
|
| 2. |
Groups objects by category (animals, foods, vehicles). |
|
|
|
| 3. |
Understands negatives (responds to no, not now...). |
|
|
|
| 4. |
Receptively identifies colors (red and blue.) |
|
|
|
| 5. |
Understands positional concept (on, off, in, out). |
|
|
|
| 6. |
Provides object function (phone, pencil). "What do we _____with?" |
|
|
|
| 7. |
Answers simple questions appropriately (1 to 3 word responses). |
|
|
|
| 8. |
Gives own first name and age and sex. |
|
|
|
| 9. |
Talks about what happened in the past or objects out of view. |
|
|
|
| 10. |
Articulated clearly, can be understood 80% of the time. |
|
|
|
|
Cognitive Skills: |
|
|
|
| 1. |
Completes shape form board unassisted. |
|
|
|
| 2. |
Enjoys looking at books and being read to. |
|
|
|
| 3. |
Tells what to do when you are sleepy, cold, tired, hungry. |
|
|
|
| 4. |
Points to chin, thumbs, knees, neck, finger nails. |
|
|
|
| 5. |
Sorts objects by color and size. |
|
|
|
| 6. |
Can discriminate between big and little. |
|
|
|
| 7. |
Can count to 5 by rote. |
|
|
|
| 8. |
Responds to directions with positional concepts...put it in, out, on, off. |
|
|
|
| 9. |
Copies 3 part design modelled by teacher (3 block design). |
|
|
|
| 10. |
Engages in pretend play...feeds doll, drives truck, cooks food. |
|
|
|
|
Social / Emotional: |
|
|
|
| 1. |
Engages in parallel play. |
|
|
|
| 2. |
Uses manners and greetings spontaneously...please, thank you, hi, bye. |
|
|
|
| 3. |
Expresses feelings verbally...happy, sad, angry, afraid. |
|
|
|
| 4. |
Shares toys or possessions willingly or with prompts. |
|
|
|
| 5. |
Cooperates, follows simple rules and schedules, assists adults or peers. |
|
|
|
| 6. |
Takes turns with adults / peers in structured and unstructured activities. |
|
|
|
| 7. |
Engages in self-talk and conversation during play. |
|
|
|
| 8. |
Chooses own activities and attends for at least 5 minutes. |
|
|
|
| 9. |
Finishes activities. |
|
|
|
| 10. |
Friendly toward adults and peers. |
|
|
|
|
Self-Help Skills: |
|
|
|
| 1. |
Uses spoon and fork to eat. |
|
|
|
| 2. |
Pours from pitcher to cup with little spilling. |
|
|
|
| 3. |
Uses napkin for wiping mouth. |
|
|
|
| 4. |
Buttons a large button. |
|
|
|
| 5. |
Pulls up garments with elastic waists. |
|
|
|
| 6. |
Puts on socks. |
|
|
|
| 7. |
Undresses self. |
|
|
|
| 8. |
Shows awareness of dangers...hot, traffic, falling. |
|
|
|
| 9. |
Toilets with little or no help. |
|
|
|
| 10. |
Washes hands with assistance. |
|
|
|
|
Fine and Gross Motor Skills: |
|
|
|
| 1. |
Can imitate circle. |
|
|
|
| 2. |
Can stack at least 9 blocks. |
|
|
|
| 3. |
Wiggles thumb in imitation. |
|
|
|
| 4. |
Folds paper as demonstrated in half. |
|
|
|
| 5. |
Cuts paper (1 cut) without assistance. |
|
|
|
| 6. |
Strings one bead within 10 seconds. |
|
|
|
| 7. |
Rolls clay into balls. |
|
|
|
| 8. |
Catches basketball size ball with body. |
|
|
|
| 9. |
Walks up and down stairs alternating feet while holding rail. |
|
|
|
| 10. |
Runs 10 feet without falling or bumping into objects. |
|
|
|