SOCIAL, EMOTIONAL, BEHAVIORAL SKILLS CHECKLIST

NAME TEACHER DATE

If “no” please attach comments/documentation:

Social Behavioral Skills

Yes No Student has good eye contact with peers

Yes No Student is able to share and interact cooperatively with peers
Yes No Student is able to start conversations with peers
Yes No Student is able to ignore peers when he/she should
Yes No Student is passive with peers
Yes No Student is aggressive with peers

Social and General Problem-Solving Skills

Yes No Student understands the consequences of behavior

Yes No Student behavior is goal oriented
Yes No Student is aware when he/she is having a problem
Yes No Student learns from past mistakes and does not repeat them
Yes No Student uses appropriate strategies to solve interpersonal difficulties
Yes No Student uses aggressive solutions to solve disagreements with others

Ability to Cope with Anger

Yes No Student is aware that he/she is getting angry or frustrated

Yes No Student responds to anger with appropriate coping skills (uses coping skills)
Yes No Student keeps anger under-control (does not blow-up or have anger outbursts
Yes No Student can handle minor frustrations without adult assistance
Yes No Student is happy most days

Ability to Engage in Self-Directed Academic Behaviors

Yes No Student is able to organize school materials

Yes No Student effectively budgets his/her time
Yes No Student understands homework assignments (what is supposed to be done)
Yes No Student is usually on-task and gets work done at school
Yes No Student usually completes homework assignments
Yes No Student has good study skills/habits

Emotional Well-Being and Level of Self-Esteem

Yes No Student acknowledges his/her own feelings

Yes No Student expresses feelings in appropriate ways
Yes No Student is able to tell others about his/her concerns/troubles
Yes No Student thinks and verbalizes positive thoughts about self and others
Yes No Student seems to like himself/herself (can identify positive self qualities)
Yes No 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.