Family Observation of Progress & Goal Areas

Name *
Child's Date of Birth
Child's Date of Birth
WALKING (needs hand held, assistive device; stairs-use of railing, one foot on each step)
GROSS MOTOR SKILLS (kicking, climbing, jumping, running)
PLAY SKILLS (ball play, bike riding, turn taking, uses both hands to play)
ENDURANCE (able to walk long distances, needs rest breaks, able to sit upright for certain durations, uses arms for support)
STRENGTH (performs transitions, needs how much help to perform weight bearing activities, uses both hands to lift/carry objects)
BALANCE (walking on uneven surfaces, inclines, grassy terrain, stairs; ability to prevent falls during standing, walking sitting, uses hands to help)
SOCIAL (engages, peer interaction, self injurous or abusive to others)
COMMUNICATION (needs prompts, uses 3-4 word sentences, able to hold conversations)
BODY AWARENESS (standing in line at school, hold a tray without spilling objects, sensory seekign behaviors)
SELF CARE (what help is needed to eat, dress, bathe)
ATTENTION/FOCUS (frequent redirection, eye contact, follows commands)
SENSORY INTEGRATION (under - or over-reactive to touch, sound, taste, visual input, odors)
SELF-REGULATION (arousal level, behavior, sleep, modd swings)