Long Beach School District
Classroom Observation Report
Student Identification
STUDENT: ________________________________________
SCHOOL:
QES
RES
HMES
LBMS
MSIS#: _______________________
LBHS
GRADE: _________
Observer Identification
NAME: ___________________________________
Position: _____________________________
Observation Setting
TEACHER: _________________________________________
Subject Observed:
Class Size:
Student Seated In:
________
□ Front
□ Back
Grade level of:
Instruction: _______
Materials: ________
Amount of time allotted for:
Teacher Instruction: _________ Independent Work: ________
Student support services observed during class:
□ Tutor
□ Peer Tutor
□ Parent Helper
□ Behavioral Support Personnel
Did support personnel work one-to-one with the student? □ Yes
□ No
Check if any evaluation procedures conducted during the observation:
□ Written test
□ Oral test
□ Demonstration
□ Other: ___________________
Instructions given to student:
□ Verbal □ Written on paper
□ Written on AV equip.
Student observed during (check all that apply):
□ Independent written work
□ Independent reading
□ Responding orally
□
Listening
Additional comments by observer:
□
Other: ___________________
In comparison to the peer group:
Was student attentive the majority of the observation?
If no, describe inattentive details:
Did student receive assistance during class?
If yes, who helped student? __________________
Did student begin work with unnecessary delay?
Did student ask for clarification of directions before beginning work?
Skills Observed
State the task(s) the child was required to perform during the observation:
Support
Person
BEHAVIOR
Withdrawn
Aggressive
Communicates appropriately
Reacts appropriately
Peer
Social behaviors:
(Place a check indicating how the student
interacts with each individual on scale).
Comments:
Teacher
Student Behavior Observed
□
Yes
□
No
□
Yes
□
No
□
□
Yes
Yes
□
□
No
No
Summarize observation and explain the relationship of observed behavior to academic functioning.
_______________________________
Observer Signature
_______________________________
Date of Observation