Observation Report Form Template (Page 2 of 2) in pdf

Description of Student Behavior: Check all items that apply or mark frequently observed

___withdrawn

___attentive in class

___inattentive in class

___disrupts classroom procedures

___asks teacher to repeat

___follows directions

___constantly seeking others’ approval

___seems to understand directions

___displays unusual behaviors

___hyperactive

___unable to sit still

___looks at other’s papers

___taps fingers, ruler, pencil, etc.

___stumbles on words

___asks many questions

___can’t stay in line

___short attention span

___distracted by noises

___irritable temperament

___confusion with directions

___seemingly unmotivated

___sits and does nothing

___appears to be uncoordinated

___immature speech/language

___excessive physical contact

___completes written assignments

___handles a pen or pencil awkwardly

___erases often

___work area is unusually messy

___seems to recall facts or simple ideas

___does not follow directions adequately

___wears glasses

___unkempt appearance

___seems shy

___reversals

___inappropriate discussion responses

___points rather than speaking

___excessive display of affection

___stares off

___blurts out answers

___sits up on desk or legs

___other:_______________________

Additional Information:

_____________________________________________________________________________________

____________________________________________________________________________________

In the judgment of the classroom teacher, was the student’s behavior during this observation “typical”

of his/her usual school performance _____yes, _____no

Observation Report Form Template Page 2

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