Occupational Therapy School Skills Assessment Therapy School Skills Assessment TherapyFunZone.com...

Occupational Therapy School Skills Assessment

TherapyFunZone.com 2010 1

Name: Date:Date of Birth: Age: School: Therapist:

Right Left First Last

Notes: Notes:

Tripod Quadrupod Adapted tripod Gross PronatedDynamic

Static5 finger Thumb tuck Thumb wrap Tripod, closed

web spaceFinger wrap

Notes:

? — ? ? + X ? ?

Notes:

Straight line Curved line Circle Square Picture Hold paper

Move paperNotes:

Handed: Able to write name:

Pencil grasp:

Copy shapesFollow Maze

Scissor Skills



(translation, shift, and rotation) Yes NoSquirrel 5 coins into palmMove coins from palm back to fingersMove two balls or marbles around in handMove pencil with one hand from writing to erasing positionCircle the type of grasps attained:Gross Palmar Scissors Radial Digital Neat PincerNotes:

Yes NoAble to follow an object with eyes? Left and Right

Up and DownAble to copy letters from the letter board to paper?When bringing an object towards eyes, do they converge naturally?Notes:

Total Number Number wrong Number right Percent correctNumber of Letters in sample

Letter formationLine placement

Number of Letter spaces in sampleNumber of Word spaces in sampleNumber of Sentence spaces in sample

In-Hand Manipulation Skills

Visual Tracking

Handwriting Sample



Copy Shapes



Cut on the lines



Follow the maze with your pencil. Stay inside the lines.

Start

Follow The Maze



Hold this paper up high in front of the student and have them copy each letter in order one at a time. This simulates copying work from the board.

A M

F L

T K

P D

R C

S O

H Z

Letter Board



Handwriting

Copy

Dictate

Student Name ___________________________Date_________

I like to pet a dog.



Handwriting

Self-generated SentencesWrite 1-3 sentences about the picture, or another subject.



Functional School Skills Assessment

Student: School: DOB:Therapist: Teacher: Date:

Assessment Scale: 1 = unable, 2 = poor, 3 = functional, 4 = age level or above

Put on/take off coatOpen and close zippersButtonSnapTie a bowPut on/take off boots, shoesOpen backpackHang jacket and backpack on hookGet books in and out of backpackManage lockerSafely and efficiently negotiates school settingNegotiates gym related/playground activitiesTurn, push, pull knobs to school doors

Negotiate obstacles in the lunch room (tables, cansSeat self at table safelyManage money at food lineCarry tray to table Open food packagesEat and drink without excessive messUse utensils for eatingPour liquidsUse a napkinClean up space after eatingOpen and close lunch box

SCHOOL RELATED SELF CARE SKILLS 1 2 3 4 COMMENTS

NEGOTIATE THE SCHOOL CAFETERIA 1 2 3 4 COMMENTS



Manage door in and out of bathroomManage clothes fasteners for toiletingManage clothing (pants up down)Get on and off the toiletReach toilet paperWipe independentlyReach the sinkWash handsDry hands

Sit at desk in upright positionSit in chair without fallingMaintain balance while doing table top activitiesModulate activity levelRespond appropriately to unexpected or loud noiseRemain focused on tasks with distractionsTolerate textures of clothing or classroom materialTransition from one activity to anotherOrganize desk, notebook, folders, and backpackAble to use scissorsAble to use glueAble to use a rulerAble to use a staplerAble to use a computerGet books and papers in and out of deskWrite on white board

Uses a mature grasp pattern for writingWriting legibleCorrect letter formationSpaces letters and words properlyUses the right pressure on the pencilWrites within space availableColor with controlWrite with appropriate speedLeft/right progression when writing

UTILIZE THE BATHROOM 1 2 3 4 COMMENTS

CLASSROOM ACTIVITIES/MATERIALS 1 2 3 4 COMMENTS

HANDWRITING 1 2 3 4 COMMENTS

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