Student Observation Form
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STUDENT OBSERVATION FORM
RE 1c
(To be completed by SST designee)
You must "Save As" this form as a "PDF" on your computer before filling out, or your information will not be saved.
Student
School
Observation #:
Observations in at least TWO settings are required for each referral.
Observer:
Position:
Chad Keen
Lead Special Education Teacher
Subject(s) Observed/Date/Time
Subject
Date
Time
1
2
Learning Situation (Check all that apply)
Regular Classroom
Whole Class
Independent Work
Number of Adults
(teachers, TAs, etc.)
Resource Classroom
Small Group
Unstructured
Outdoors / Gym
Cooperative learning
Other
Number of Students
Individual instruction
Other
Other
Physical Environment
Lighting
Bright
Adequate
Dim
Seating Arrangement
Rows facing front
Desk clusters
U-shaped facing front
Student Placement
Middle/back of room
Front of room
Separated from other students
Temperature
Hot
Comfortable
Cold
Noise Level
Noisy
Moderate
Quiet
Student Behaviors Observed
(Please rate the student's behavior in each of the following areas relative to other students in the classroom.)
Rating
Summarize and discuss the
Strength
Age-Appropriate
Weakness
student's observed academic and
(Above Average)
(Average)
(Below Average)
Academic/Instructional Behaviors
functional skills (include strengths
Skills related to the academic task
and weaknesses noted):
Attentive to instruction and tasks
Follows along with instruction/task
Constructively contributes to class
Follow teacher directions/task instructions
Organized work and work habits
Works carefully and neatly
Completes tasks
Work willingly and without frustration
Social Behaviors
Friendly and respectful toward adults
Friendly and respectful toward peers
Interacts appropriately with peers in social setting
Interacts appropriately with peers in academic setting
Respects others' safety and personal space
Engages with peers
General Behavior and Conduct
Staying in seat
Activity level
Talking out
Behaviors disrupt class
Attention span
Easily excitable
Signature of Observer
Date
OHS-OCS PS 09/12
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