SOCIAL, EMOTIONAL, BEHAVIORAL SKILLS CHECKLIST
NAME
TEACHER
DATE
If “no” please attach comments/documentation:
Social Behavioral Skills
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Student has good eye contact with peers
Student is able to share and interact cooperatively with peers
Student is able to start conversations with peers
Student is able to ignore peers when he/she should
Student is passive with peers
Student is aggressive with peers
Social and General Problem-Solving Skills
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Student understands the consequences of behavior
Student behavior is goal oriented
Student is aware when he/she is having a problem
Student learns from past mistakes and does not repeat them
Student uses appropriate strategies to solve interpersonal difficulties
Student uses aggressive solutions to solve disagreements with others
Ability to Cope with Anger
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
Student is aware that he/she is getting angry or frustrated
Student responds to anger with appropriate coping skills (uses coping skills)
Student keeps anger under-control (does not blow-up or have anger outbursts
Student can handle minor frustrations without adult assistance
Student is happy most days
Ability to Engage in Self-Directed Academic Behaviors
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Student is able to organize school materials
Student effectively budgets his/her time
Student understands homework assignments (what is supposed to be done)
Student is usually on-task and gets work done at school
Student usually completes homework assignments
Student has good study skills/habits
Emotional Well-Being and Level of Self-Esteem
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
Student acknowledges his/her own feelings
Student expresses feelings in appropriate ways
Student is able to tell others about his/her concerns/troubles
Student thinks and verbalizes positive thoughts about self and others
Student seems to like himself/herself (can identify positive self qualities)
Student is able to take responsibility for achievements and mistakes
Please attach the following if applicable:
Incident reports / discipline records
Teacher reports
Parent reports and information provided by the parent
Developmental profiles
Previous behavior intervention plans
Anecdotal records
If a review indicates current concerns in the above areas, the student’s social / emotional / behavioral status is “at risk”.
Documented, evidence-based intervention(s) appropriate to the student’s age and behavioral difficulties shall be conducted
with fidelity for the length of time necessary to obtain sufficient data to determine their effectiveness. Interventions are
required for students with a suspected emotional disturbance unless there is substantial documentation that the student is
likely to injure himself/herself or others.
St. Landry Parish / September 2009