Physical Development | SEIT Assessment

1. Which of the following movements does the child perform?

Walking Running Hopping Jumping Skipping Galloping Other:

2. How would you describe the child's balance and coordination?

Typical/Age appropriate Immature

3. Does the child ascend and descend stairs alternating feet?

Yes No

4. Does the child hold onto the railing for support while using stairs?

Yes No

5. Which ball-related skills does the child demonstrate?

Catching a ball Throwing a ball Kicking a ball Bouncing a ball Other:

6. Does the child participate in music and movement activities, mimicking motions and following directions?

Yes No

7. Does the child navigate indoor/outdoor gym and play equipment, including an obstacle course?

Yes No

8. Does the child indicate a dominant hand?

Yes No

9. If yes, specify which hand?

Right Left

10. Does the child string assorted-sized beads?

Yes No Other:

11. Does the child lace cards?

Yes No Other:

12. Does the child independently open:

Toy bins Snack packs Juice/milk containers

13. How does the child grasp writing/coloring tools?

Tripod grasp (correct mature grip) Fisted grasp Quadruped grasp Other:

14. Does the child hold a paper with non-dominant hand while drawing with dominant hand?

Yes No

15. Which pre-writing/writing skills does the child demonstrate?

Tracing Copying Writing letters Writing numbers Writing name Drawing shapes Other:

16. Does the child imitate horizontal and vertical lines?

Yes No

17. Does the child use lines in drawings?

Yes No

18. Does the child draw a figure with recognizable features?

Yes No

19. If a child draws a figure, specify how many features:

20. Does the child color within the borders of a picture?

Yes No

21. How does the child manipulate scissors?

Uses scissors independently Requires hand-over-hand support Does not use scissors yet

22. What scissor skills does the child perform?

Snipping paper Cutting along a straight line Cutting along a curved line Cutting out geometric shapes Other:

23. Does the child spread glue on one side of the paper and turn it over to stick to another paper (not important to align the two sheets)?

Yes No

24. Does the child complete age-appropriate puzzles?

Yes No

25. Does the child reproduce and create patterns?

Yes No Other:

26. Does the child demonstrate sensory-seeking or self-stimulatory behaviors?

27. Does the child exhibit sensory avoidance behaviors?

Avoids bright lights Avoids loud sounds Avoids certain textures Avoids certain tastes Avoids certain smells Other:

28. Does the child self-feed?

Yes No

29. Does the child use utensils appropriately for their age?

Yes No

30. Does the child eat a variety of textured foods?

Yes No

31. Is the child a neat or messy eater?

Neat Messy

32. Does the child use a napkin to wipe their hands and mouth during and after meals?

Yes No

33. Does the child drink from a regular cup without spilling it?

Yes No

34. Does the child use the toilet independently and follow bathroom procedures?

Yes No

35. Does the child dress and undress independently?

Yes No Other:

36. Does child independently manipulate fasteners?

Buttons Zippers Snaps N/A

37. Does the child remove their shoes and socks?

Yes No

38. Does the child put their shoes on the correct feet?

Yes No

39. Does the child use tissues to wipe their nose?

Independently Requires reminders Needs assistance

40. Is the child receiving occupational or physical therapy services?

Yes No

41. If yes, have you conferred with the provider regarding the child's progress?

Yes No

42. What are the child's physical strengths?

Strong gross motor skills (running, jumping, climbing) Strong fine motor skills (drawing, cutting, building) Good balance and coordination Strong ability to mimic movements Other:

43. What physical activities does the child enjoy?

44. What are the physical development needs of the child?

45. Have parents expressed concerns about their child's physical or motor development?

Yes No

46. If yes, what concerns have the parents shared?

Physical Development Assessment

A. Gross Motor Skills

B. Fine Motor Skills

C. Sensory Concerns

D. ADL (Activities of Daily Living) Skills

E. Student Strengths, Preferences, and Interests

F. Physical Development Needs and Parent Concerns