ELEMENTARY CHECKLIST
SOCIALIZATION
Yes No
Interact with peers at recess
Eat lunch with peers
Attend special classes (i.e., music, gym, art, library) with LINK support
Attend special all-school assemblies with LINK support
Respond appropriately to peer greetings in hallway
Go on community outings with adult and/or peer support
Go on field trip with adult and/or peer support
Comments: ______
______
______
______
BEHAVIORAL
Yes No
Respond to some type of behavior system
Be toilet-trained
Attend to peer behavior & demonstrate peer modeling
Sit in a chair at a table/desk
Sit on the floor/rug
Sit in a timeout chair
What are some significant behaviors?
Positive behaviors: ______
______
Challenging behaviors: ______
______
Comments: ______
______
______
______
ACADEMIC
Yes No
Focus on/attend to a task for a 20-minute period
Complete paper/pencil tasks
Possess directional understanding (left to right & top to bottom)
Understand task completion
What are some specific interests? ______
______
What are some specific strengths? ______
______
What are some areas of challenge? ______
______
Able to participate in a general education classroom with LINK and/or adult support
Comments: ______
______
______
______
INDEPENDENCE
Yes No
Ability to follow a daily schedule system independently
Possess self-help skills:
Yes No
Able to dress self
Able to undress self
Able to feed self independently
Able to toilet independently
Able to wash independently
Able to brush teeth independently
Able to brush hair independently
Initiate use of restroom
Develop recreational/leisure skills
Yes No
Able to play with toys
Able to participate in games
Walk in line without physical support
Organize their belongings:
Yes No
Put coat away
Put bag away
Carry own books/bag
Comments: ______
______
______
______
COMMUNICATION
Yes No
Make object choices
Make word choices
Accept physical support for communication purposes (i.e., hand, wrist, or forearm support)
Initiate communication of needs/wants
Respond to verbal directives/possess receptive language skills
What are current communication methods? ______
______
Comments: ______
______
______
______
BUILDING NORMS
Yes No
Ability to walk quietly down halls
Understand process of turn-taking
Increase wait time
Possess some level of interactive & appropriate play with peers
Able to self-monitor voice tone
Generalization of authority figures
Comments: ______
______
______
______
HEALTH
What are current medications, if any? ______
Are there any weight/diet concerns? ______
______
Yes No
Does the student seizure?
Are there any visual impairments?
Are there any auditory impairments?
Are there any physical impairments?
Are there any allergies?
What side is dominant? ______
Comments: ______
______
______
______
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