BRANTLEY COUNTY SCHOOL SYSTEM
Performance Checklist
Name______________________ Completed by___________________
Please check only those behaviors which are most characteristic of this student.
DATE: _____________
Social-Emotional: __Demands excessive attention
__ Assumes leadership in group
__ Plays well with other students
__ Exhibits uncooperative behavior
__ Has only a few close friends at school
__ Seems well adjusted emotionally
__ Lacks motivation, apathetic
__ Does not adjust readily to change
__ Careless about physical condition
__ Lacks respect for property of others
__ Seems more immature than majority
__ Overly dependent on others
__ Overly anxious to please
__ Tries to control others
__ Disturbs other students
__ Behavior unpredictable, mood varies
__ Relates well to adults
__ Absent frequently
__ Easily distracted
__ Self-control poor
__ Overly sensitive
__ Appears unhappy
__ Poor sport
__ Daydreams
__ Restless
__ Fearful
__ Lacks appropriate feelings of guilt
__ Prefers fantasy to reality
__ Uses abusive language (swearing, name-calling)
__ Potentially dangerous to self or others
__ Shy, withdrawn
__ Appears happy
__ Aggressive toward others
__ Loud, Boisterous
Study Skills/Learning Behavior:
__ Puts forth best effort, but fails
__ Seldom completes tasks in allotted time
__ Needs much individual help
__ Does not work well independently
__ Difficulty following directions
__ Poor communication skills
__ Does not react appropriately to success
__ Disorganized work habits
__ Poor concept of time
__ Ignores school rules
__ Easily distracted from task at hand
__ Unable to recall events in sequence
__ Give inappropriate answers
__ Does not react appropriately to praise
__ Unable to remember general facts and information
__ Inattentive during class activities
__ Uses immature or inappropriate vocabulary
__ Quality of work varies
Physical Health:
__ Drowsy
__ Stomach aches
__ Runny nose
__ Earaches
__ Cough
__ Poor appetite
__ Headaches
__ Toothaches
__ Tics
__ Seizures
Motor Behavior:
__ Works at a slower pace than peers
__ Reverses or rotates letters or words
__ Speech, vision, hearing difficulties
__ Unable to copy from the blackboard/book
__ Coordination is poor- impacts participation
__ Overly active
__ Large muscle coordination is weak
__ Fine motor skills are weak
__ Poor directionality (gets lost in building)
__ Unable to judge relationships (big/little)
Communication Skills:
__Speaking/listening vocabulary is poor for age
__ Poor grammar usage
__ Difficulty relating info in sequence
__ Uses one or two word responses
__ Has trouble “finding” the correct word
__ Poor enunciation
__ Difficulty exchanging meaningful conversation w/ peers and/or adults
__ Limited oral communication- uses gestures
__ Has trouble answering questions and formulating answers into spoken language
__ Difficulty understanding/following verbal directions
__ Does not understand age appropriate humor, slang, figures of speech.
__ Cannot paraphrase oral info
__ Seems “lost” during class discussions
__ Cannot make logical inferences/conclusions