Reinforcer Assessment

REINFORCER ASSESSMENT

Name:______Date:______

INSTRUCTIONS:Use a check mark to indicate the items preferred.

ACTIVITY REINFORCERS

Music

List Preferred Music______

Playing with Toys

List Preferred Toys______

PuzzlesComputerWater Play

Outside PlaySnack TimeFree Time

Playing with petsRiding ToysBooks/Stories

Going for walkMaking choicesHelping Adults

DrawingPaintingBeing read to

Job ResponsibilitiesWearing CosmeticsVisiting

Wearing JewelrySpecial seatBalloons

More IndependenceRiding BikeCooking

List Preferred Materials:

Computer

List Preferred Programs______

Social Activities

List Preferred Types______

Leisure Activities

List Preferred Types______

REINFORCER ASSESSMENT

Name:______Date:______

INSTRUCTIONS:Use a check mark to indicate the items preferred.

TANGIBLE ITEMS

Chips

List Preferred Types______

Candy

List Preferred Types______

Fruit

List Preferred Types______

Cereal

List Preferred Types______

Snacks

List Preferred Types______

Drinks

List Preferred Types______

Other Preferred Foods______

Stickers

List Preferred Types______

Toys

List Preferred Types______

Games

List Preferred Types______

List Other______

REINFORCER ASSESSMENT

Name:______Date:______

INSTRUCTIONS:Use a check mark to indicate the items preferred.

AREAS OF INTEREST

Animals

List Preferred Types______

WeatherTrucksTrains

DinosaursCarsScience

MathNumbersShapes

MachinesToolsClothes

OutdoorsSportsComputers

List favorite TV Programs______

List Favorite celebrities______

List Favorite Colors______

List Favorite Movies______

List Favorite Songs______

List Favorite Places______

Other______

MISCELLANEOUS INFORMATION

List Foods Disliked______

List Noises Disliked______

List Activities Disliked______

List Places Does not like to go______

List Materials Disliked______

List Animals Disliked______

List Any other dislikes______

List Any Known Fears______

REINFORCER ASSESSMENT

Name:______Date:______

INSTRUCTIONS:Use a check mark to indicate the items preferred.

SOCIAL AND SENSORY REINFORCERS

Adult attention

Attention from specific adult

List preferred adults______

Being left alone

Time spent with peer

List preferred peers______

Freedom from interference from adults

Freedom from interference from peers

A positive note to give a person of choice

HugsPraiseStim Time

Private PraisePublic recognitionPublic praise

Being rockedBeing heldApplause

OK SignBack RubTickles

Sit in Adult’s lapThumbs UpShake Hands

High FivePatsTwirl Around

SwingingBeing BrushedJumping

VibratorLotionPowder

Roll Up on blanketSmilesMotor Lab/Room

Blowing BubblesShoes offCologne

List Other:______