Assistive Technology Assessment Checklist
For Students with Visual Impairments
Student Name ____________________________ Date of assessment ____________
Person Completing Checklist ________________ Position ______________________
During this assessment, informal measures were utilized to evaluate the student’s ability to
access print, produce written communication, access the computer, and use various assistive
technologies. Some of the information requested may be obtained from the Learning Media
Assessment, the Clinical Low Vision Evaluation, or the Functional Low Vision Evaluation.
Accessing Print
Regular Print
When accessing printed information visually the student is able to read regular print materials
_____ at _____ inches without adaptations.
_____ at _____ inches with adaptations.
_____ using prescribed eyeglasses or contact lens.
_____ enlarged on photocopying machine - Specify (i.e. 130%, 3 times) _____
___ 8 ½" x 11" paper.
___ 8 ½" x 14" paper.
___ 11" x 17" paper.
with or without adaptations for _____ min before experiencing either visual or physical
fatigue.
Large Print
The student is able to identify black & white line drawings of common objects
_____ 3 inches high at approximately ___ inches.
_____ 2 inches high at approximately ___ inches.
_____ 1 inch high at approximately ___ inches.
When accessing large print with prescribed eyeglasses or contact lens (if appropriate) the
student is able to read
72 point print at approximately _____ inches.
60 point print at approximately _____ inches.
48 point print at approximately _____ inches.
36 point print at approximately _____ inches.
30 point print at approximately _____ inches.
24 point print at approximately _____ inches.
18 point print at approximately _____ inches.
14 point print at approximately _____ inches.
12 point print at approximately _____ inches.
The student’s preferred font is ___ Arial, ___ APHont, ___ Tahoma, ____ Verdana
Other (specify) ______________________________________
The student’s preferred point size with prescribed eyeglasses or contact lens is
___ 14 ___ 18 ___ 24 ___ 30 ___ 36 ___ 48 ___ 60 ___ 72.
Optical Devices
When accessing printed materials with the use of a prescribed optical device, the student uses
_____ eyeglasses _____ contact lens
_____ hand held or
_____ stand magnifier, power _____
_____ telescope, power ________
_____ video magnifier
When accessing printed materials with the use of a video magnifier/Closed Circuit TeleVision
(CCTV), the student is able to view a
_____ inch high graphic, and a
_____ inch high text on a
_____ inch monitor at approximately 13-16 inches.
The student's polarity preference is _____ dark on light, or _____ light on dark.
The student's color combination preference is ______________________________.
When using the controls of the video magnifier, the student is able to:
_____ adjust size of image.
_____ focus image.
_____ independently use X/Y table for viewing materials with friction brake and margin
stops are adjusted by examiner. Examiner comments
________________________________________________________________
________________________________________________________________
When asked, the student is able to
_____ write a short sentence legibly on regular writing paper while
___ looking at the screen/monitor, or
___ looking at the paper.
_____ write a short sentence legibly on bold line paper while
_____ looking at the screen/monitor, or
_____ looking at the paper.
The student is able to read approximately
_____ wpm orally when the friction brake and margin stops are adjusted properly by the
examiner.
The student is able to
_____ read a sample sentence of his/her hand writing on regular writing paper.
_____ read a sample sentence of his/her hand writing on bold line writing paper.
When viewing printed materials scanned into the computer with a specialized scanning system
(Kurzweil, OpenBook, WYNN), the student is able to
_____ adjust the magnification to the desired size using
___ the keyboard, or the ___ mouse.
_____ navigate the image horizontally and vertically using
___ the keyboard, or the ___ mouse.
_____ select items from the menus and tools from the toolbar with the
___ keyboard, or the ___ mouse.
Non-Optical Devices
When accessing information through the use of non-optical devices, the student
_____ reads text written with a pen on regular blue line paper.
_____ prefers reading materials produced with felt tip pen on bold line paper.
_____
prefers incandescent lighting, ___ fluorescent lighting, ___ halogen lighting.
_____
prefers overhead lighting using a dimmer switch.
_____
prefers window lighting adjusted with
___ blinds, ___ shades, or ___ other - Specify ________________________
_____ experiences glare problems from
___ overhead lighting, ___ window lighting.
_____ prefers less lighting than currently available.
_____ prefers additional lighting with
___ desk lamp, ___ floor lamp, ___ additional overhead lighting.
_____ prefers to have materials ___ placed on a reading stand, ___ placed on the table/desk,
___ held in hand.
Braille and Tactile
When accessing graphical information tactually the student is able to identify
_____ solid lines of various heights.
_____ solid lines of various widths.
_____ dashed lines.
_____ dotted lines.
_____ the boundary between two clearly defined textured fill patterns.
_____ the boundary between three clearly defined textured fill patterns.
_____ the boundary between four clearly defined textured fill patterns.
The student is able to identify tactile information most accurately when it is presented as a
simple tactile graphic
_____ tooled onto braille paper.
_____ produced as a collage.
_____ thermoformed onto plastic.
_____ embossed as dots and lines onto braille paper by a computer controlled braille
embosser.
_____ produced as raised lines and patterns on encapsulated paper.
_____ Student is able to read materials in braille.
_____ Results of formal/informal braille assessments conducted by TVI are attached.
Student’s oral braille reading rate is _____ wpm
Student’s silent braille reading rate is _____ wpm
When accessing printed information with an electronic/refreshable braille display, the student
is able to
_____ read letters, words, and sentences.
_____ press correct key combination to issue forward and reverse navigation commands with
verbal prompt.
_____ press correct key combination to issue forward and reverse navigation commands with
out verbal prompt.
_____ read ___wpm aurally and ___wpm silently.
Auditory
When accessing printed information auditorally, the student is able to
_____ demonstrate comprehension by answering simple questions & relating details about a
passage when it is read to him/her.
_____ paraphrase information presented orally (sentence or story.)
_____ write, type, or braille dictated words and phrases without having it repeated more than
twice.
When using an analog or digital player/recorder the student is able to
_____ insert and remove tape/CD from player/recorder.
_____ activate play, pause, stop, fast forward and rewind functions (please underline those
demonstrated.)
_____ understand and comprehend compressed or “fast” speech.
_____ manipulate variable speed and pitch controls.
_____ identify index tones.
Reading Rates (This is an optional section used when needed to demonstrate to the student,
parents, teachers, or administrators the benefits of using adaptations when reading.)
When reading printed information, the student is able to read
_____ wpm orally when provided with 12 point materials.
_____ wpm orally when provided with materials in the optimum size for viewing at 10 13 inches (_____ point print.)
_____ wpm orally when using a video magnifier/CCTV.
_____ wpm orally when provided with materials in braille.
_____ wpm when using audio assisted reading.
Electronic Calculators and Dictionaries
When using a calculator with an enlarged display, the student is able to
_____ see _____ inch numerals.
_____ accurately locate and press the keys on the calculator keypad.
perform basic operations
___ with prompting,
___ without prompting.
When using a talking calculator, the student is able to
_____ understand the synthesized speech produced by a talking calculator.
_____ accurately manipulate keys on a talking calculator.
perform basic functions
___ with prompting,
___ without prompting.
When using a talking dictionary, the student is able to
_____ understand distinctive sounding letters (a, f, h, o, s, w, etc.).
_____ understand similar sounding letters (b, c, d, e, p, t, z).
_____ understand definitions spoken as individual words.
_____ understand definitions spoken as continuous speech.
_____ accurately locate and press the keys on the dictionary’s keyboard.
perform basic functions
___ with prompting,
___ without prompting.
Accessing Information on Chalk/White Board, Overhead/Computer Projector, Videos,
etc.
When accessing information presented on a chalk board/white board or overhead projector,
the student reported that he/she
_____ sits close enough to read board.
_____ uses a hand held or spectacle mounted telescope
_____ gets an accessible copy from the teacher
_____ gets an accessible copy from another student.
_____ has information read aloud by a peer or para-educator and
_____ brailles on braille writer or accessible PDA.
_____ writes information on paper.
_____ types information into computer or accessible PDA.
_____ records on tape recorder or digital recorder.
_____ Other, please specify _________________________________________
Are these options working adequately? ___ yes ___ no Explain briefly:
________________________________________________________________
________________________________________________________________
Accessing Electronic Information – Computer Access
Visual
When accessing electronic information on a desktop computer or in the computer lab the
student is able to view
_____ menus, icon titles, dialog boxes and other system text items on a
17 inch monitor at approximately _____ inches.
19 inch monitor at approximately _____ inches.
21 inch monitor at approximately _____ inches.
_____ regular, ___ bold
___ point print in an
___ Arial,
___ APHont,
___ Tahoma,
___ Verdana font
displayed on a _____ inch monitor at approximately 13 inches.
information on ____ inch computer monitor with the use of
_____ screen magnification hardware (CompuLenz) at approximately
____ inches.
_____ flexible arm monitor stand at approximately _____ inches.
screen enhancements provided with computer operating system
_____ preferred Windows Display Appearance Scheme ___________________
_____ preferred Windows Display Appearance settings (Check the Items adjusted and
note the settings for each Item on the checklist in Sidebar 7-4.)
_____ Microsoft Magnifier
___ Magnification Level
___ Other setting: Specify _____________________________________
When using Microsoft Magnifier the student is able to
___ identify screen elements.
___ read text in menus, dialog boxes, and text documents.
___ navigate around the screen.
___ locate the Title Bar of the Open file dialog box.
___ locate the file names listed in the Open file dialog box.
___ select a requested file to open.
When accessing the computer through the use of screen magnification software, the student
_____ is able to read 12 point print enlarged to _____x magnification at a viewing distance of
approximately 13 inches.
expressed a polarity preference for;
_____ dark text on alight background,
_____ light text on a dark background.
_____ is able to locate and select menu items, buttons, and other screen elements with the
mouse/pointing device.
_____ is able to locate and select menu items, buttons, and other screen elements using
keyboard commands.
is able to navigate around the magnified image using
___ the mouse/pointing device.
___ keyboard commands.
___ is able to maintain orientation when navigating around the screen.
___ is not able to maintain orientation when navigating around the screen.
expressed a viewing mode preference. Specify ______________________________
_____ is unable to access the computer visually.
Tactile
When accessing electronic or computer based information tactually, the student is able to
_____ read braille text displayed on an electronic refreshable braille display.
_____ execute navigation commands with instruction.
_____ enter text through the braille keyboard.
Auditory
When accessing electronic information auditorally, the student is able to understand
synthesized speech produced by
software synthesizers
___ Kids Time Deluxe
___ Dr. Pete’s
___ Intellitalk
___ Write Outloud
___ Flextalk
___ TrueVoice
___ Dectalk Access 32
___ Eloquence
___ WindowEyes
___ OpenBook
___ Other__________________________________
hardware synthesizers
___ Braille/Type ‘n Speak/Braille Lite
___ Dectalk
___ Double Talk
___ Other_______________________
_____When accessing electronic information auditorally, the student is not able to understand
synthesized speech produced by software or hardware synthesizers.
When accessing electronic information auditorally, the student is able to execute navigation
commands with instruction to read by
___ sentence/lines,
___ words,
___ characters,
___ forward (next) and ___ backwards (prior).
_____ When accessing electronic information auditorally, the student is not able to grasp the
concept of navigation.
Input Devices - Keyboard Use
_____ The student is able to use a standard keyboard without adaptation.
The student
___ demonstrates keyboard awareness (has a general knowledge of the key locations).
___ is able to search for keys and type individual letters
___ is able to touch type while looking at his/her hands.
___ is able to touch type without looking at his/her hands.
___ is able to locate and identify alphanumeric keys.
___ is able to locate and identify function keys.
___ is able to activate two keys simultaneously.
___ does not demonstrate excessive miss-hits or key repeats.
___ uses good mechanics when typing. (Posture, wrist elevation, etc.)
___ types with ___ fingers of right hand and ___ fingers of left hand.
_____ The student is able to utilize a standard computer keyboard with adaptations. (Seek
assistance from occupational and physical therapist as needed.)
___ zoom caps
___ keyguard
___ tactile locator dots
___ other Specify ______________________________________________
The student is able to utilize a standard computer keyboard with the following keyboard
utilities. (Seek assistance from general technology specialist, OT or PT to complete this
section.)
___ sticky keys
___ repeat keys
___ slow keys
__ toggle keys
__ mouse keys
_____ The student is not able to utilize a standard keyboard with or without adaptations. (If
checked, refer student to other members of evaluation team for a Computer Access
Evaluation.)
Use of a Pointing Device
The student is able to visually locate the Windows
___standard, ___ standard large, ___ standard extra large pointer on the screen at
approximately ___ inches on a ___ inch monitor.
___ black, ___ black large, ___ black extra large pointer on the screen at approximately
___ inches on a ___ inch monitor.
___ inverted, ___ inverted large, ___ inverted extra large pointer on the screen at
approximately ___ inches on a ___ inch monitor.
___ Other enlarged pointer
Specify _______________________________
at approximately ___ inches on a ___ inch monitor
_____ navigate the desktop with the standard mouse/trackball.
_____ The student is able to maintain the mouse position while clicking/double-clicking.
_____ The student is able to maintain eye contact with the screen while navigating the
desktop.
_____ The student is able to access pull-down menus with the standard mouse.
_____ The student is not able to use a standard mouse. (If checked for a student with low
vision please request a Computer Access Evaluation.)
Communication Through Writing
When using standard writing tools, the student is able to
_____ produce legible manuscript writing.
_____ produce legible cursive writing
_____ space appropriately between letters and words.
write _____ wpm from ___ dictation.
write _____ wpm from ___ copy.
_____ read his/her handwriting.
_____ read a sample of his/her handwriting from 3-5 days earlier.
_____ sign his/her name legibly in cursive using
___ a signature guide.
___ the edge of a card, ruler or some other similar device.
_____ produces legible writing laboriously and with great difficulty.
The student is able to produce legible
_____ manuscript writing using the following adaptations
___ bold line paper
___ raised line paper
___ a felt tip pen
___ a white board and erasable marker
___ Other _________________________________________
The student is able to produce legible
_____ cursive writing using the following adaptations
___ bold line paper
___ raised line paper
___ a felt tip pen
___ a white board and erasable marker
___ Other _________________________________________
When using a braille writing device, the student is able to use
_____ a manual brailler to emboss characters, words and sentences at ___ wpm form ___
dictation, ___ copy.
_____ a manual brailler with extension keys to emboss characters, words and sentences at
___ wpm form ___ dictation, ___ copy.
_____ a unimanual brailler to emboss characters, words and sentences at ___ wpm form ___
dictation, ___ copy.
_____ the slate & stylus to emboss characters, words and sentences at ___ wpm form ___
dictation, ___ copy.
_____ the Mountbatten brailler to emboss characters, words and sentences at ___ wpm from
___ dictation, ___ copy.
_____ an accessible PDA with a braille keyboard to emboss characters, words and sentences
at ___ wpm from ___ dictation, ___ copy.
The student is able to sign his/her name legibly in cursive using
___ a signature guide.
___ the edge of a card, ruler or some other similar device.
Electronic Tools for Producing Written Communication and for Accessing Information
When using an electronic writing device, (computer, portable note taker, accessible PDA) the
student is able to
_____ view/read the visual information being displayed by the device.
_____ understand the synthesized speech to read characters, words, and sentences.
_____ perceive the refreshable braille to read characters, words, and sentences.
_____ enter characters, words, and sentences.
_____ perform basic navigation and other functions
___ with ___ without instruction from the examiner.
_____ read ___ wpm with ____% comprehension using speech output.
_____ read ___ wpm with ____% comprehension using refreshable braille display.
Comments:_________________________________________________________________
___________________________________________________________________________
Additional Assessment Information: ________________________________________
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