LEARNING BEHAVIOR SKILLS CHECKLIST
STUDENT’S NAME:___________________________________
DATE:_____________________
RATED BY (STUDENT’S TEACHER): __________ ___________ name//subj. taught)
SCHOOL: _________________
• DIRECTIONS •
The student’s skill level may be observed or inferred from several sources of information such as interview, class
observations, or case history. Since the checklist reflects observed performance, it may be desirable to fill the
checklist after observing the student on more than one occasion and in different situations. While all students
demonstrate many of these behaviors, this checklist is designed to identify PROBLEM AREAS. The student is
rated on a scale of (0), (1), (2) using the following:
•SKILL LEVELS
(0) = Behavior not performed (student totally unable or unwilling to perform task)
(1) = Behavior performed inadequately (student required constant assistance, prompting or cuing)
(2) = Behavior performed independently (student accommodations permitted)
• Please circle the appropriate skill level for each learning behavior on the back of this page.
• Please comment on observed behavior that correlates to chosen skill levels on the back of this page
• •DO NO USE – ASSESSMENT LAB USE ONLY • •
LEARNING BEHAVIOR SKILLS PROFILE
STD Score
RAW Score
25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 105 110 115 120 130
0 4 15 18 20 22 23 26 28 29 30 31 32 33 34 35 36 37 39 40
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Raw Standard ………………………………………………………………………………………………………………..
Score Score
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Learning
Behavior
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^ GP MEAN
^--------------------^
SEVERE DEFICIT
^-----------^
^------------^
MODERATE
DEFICIT
GP MEAN IS GENERAL POPULATION MEAN
^----------------
BORDERLINE
AVERAGE
ABOVE AVERAGE
^-----------------------------^
AVERAGE
1. APPEARANCE & MANNERISMS: Groomed and appropriate personal appearance and mannerisms.
Comments:
0 1 2
2. INTERACTION WITH OTHERS: Effective communication and interaction with different people.
Comments:
0 1 2
3. DIRECTION FOLLOWING: Follows oral or written instructions.
Comments:
0 1 2
4. SAFETY STANDARDS: Follows safety standards.
Comments:
0 1 2
5. INITIATIVE: Works independently, initiates activity & asks for help when needed.
Comments:
0 1 2
6. RETENTION OF INFORMATION: Remembers instructions & task organization.
Comments:
0 1 2
7. RESPONSIBILITY: Maintains personal responsibility for materials and class work.
Comments:
0 1 2
8. ADHERENCE TO STANDARDS: Adheres to policies, rules and school schedule.
Comments:
0 1 2
9. APPLICATION OF SKILLS: Applies acquired skills to learn and perform given tasks.
Comments:
0 1 2
10. FLEXIBILITY: Accommodates to changes in class environment yet maintains productivity.
Comments:
0 1 2
11. ATTENTION TO TASK: Focuses attention & maintains performance despite distractions.
Comments:
0 1 2
12. PERSISTENCE: Sustains performance until task is completed.
Comments:
0 1 2
13. PRODUCTIVITY: Performs activities at an acceptable rate.
Comments:
0 1 2
14. QUALITY: Consistently good quality on tasks, few errors.
Comments:
0 1 2
15. ACCEPTS SUPERVISION: Accepts and responds to suggestions and corrections.
Comments:
0 1 2
16. IMPROVEMENTS OF SKILLS: Skills show noted and consistent improvement with training.
Comments:
0 1 2
17. STRESS TOLERANCE: Remains emotionally calm under stressful conditions.
Comments:
0 1 2
18. IMPULSE CONTROL: Consistent, predictable behavior; adequate self-control.
Comments:
0 1 2
19. ATTITUDE: Finds pleasure and satisfaction in performance to task.
Comments:
0 1 2
20. SELF-IMAGE: Has a positive self-image.
Comments:
0 1 2