TURNING FIVE OCCUPATIONAL THERAPY PROGRESS REPORT



Date: ____________________

Student’s Name: ______________________ OSIS#: ________________________

Date of Birth: ___________________

Functional Range of Motion: describe areas of limitations and the impact on the child’s ability to perform functional activities i.e. eating, dressing, sitting, play skills.

Fine Motor Skills:

| |Yes |No |Comments |

|Points with index finger | | | |

|Reaches for objects | | | |

|Turns pages | | | |

|Uses crayons, pencil | | | |

|Snips with scissors/thumbs up | | | |

|Cuts along line | | | |

|Cuts out circle | | | |

|Cuts out square | | | |

|Holds/turns paper while cutting | | | |

|Able to copy step pattern using 6 blocks | | | |

|Carries lunchbox | | | |

Describe Grasp:

Pre-Writing:

| |Yes |No |Comments |

|Traces a vertical line | | | |

|Traces a horizontal line | | | |

|Traces a circle | | | |

|Traces a square | | | |

|Imitates a vertical line | | | |

|Imitates a horizontal line | | | |

|Imitates a circle | | | |

|Imitates a square | | | |

|Copies a vertical line | | | |

|Copies a horizontal line | | | |

|Copies a circle | | | |

|Copies a square | | | |

|Draws a vertical line | | | |

|Draws a horizontal line | | | |

|Draws a circle | | | |

|Draws a cross | | | |

|Draws a square | | | |

|Marks, scribbles | | | |

|Connects the dots | | | |

|Colors within the lines | | | |

|Serial opposition –right | | | |

|Serial opposition- left | | | |

|Grasp pattern- circle | | | |

|Power Hook | | | |

| | | | |

|Spherical Cylindrical | | | |

|Skilled use of dominant hand | | | |

|Pinch patterns | | | |

|Lateral Pad to Pat | | | |

| | | | |

|Tip to Tip 3 jaw chuck | | | |

Communication:

| |Yes |No |Comments |

|Verbal | | | |

|Uses gestures | | | |

|Makes eye contact | | | |

|Initiates interaction | | | |

Orientation and Memory:

| |Yes |No |Comments |

|Recognizes self in mirror | | | |

|States name | | | |

|Recognizes body parts | | | |

|Remembers routines | | | |

|Recalls personal events | | | |

|Remembers auditory information | | | |

|Remembers visual information | | | |

Play:

| |Yes |No |Comments |

|Plays alone | | | |

|Plays with others | | | |

|Exhibits imaginary play | | | |

|Exhibits symbolic play | | | |

|Uses toys purposefully | | | |

|Can occupy self | | | |

Life Skills:

| |Yes |No |Comments |

|Puts on jacket | | | |

|Takes off jacket | | | |

|Puts on sweater | | | |

|Takes off sweater | | | |

|Fastens snaps | | | |

|Attempts to zipper | | | |

|Attempts buttons | | | |

|Hangs up coat | | | |

|Drinks from a cup | | | |

|Indicates need to use bathroom in a timely | | | |

|manner | | | |

|Moves from classroom to bathroom and | | | |

|bathroom to classroom | | | |

|Enters and exits stall | | | |

|Locks and unlocks door | | | |

|Manages clothing | | | |

|Obtains toilet paper | | | |

|Uses toilet paper | | | |

|Washes hands | | | |

Self Regulation and Attention:

| |Yes |No |Comments |

|Notices the environment | | | |

|Attends during instruction | | | |

|Follows simple directions | | | |

|Works independently | | | |

|Shifts attention as needed | | | |

|Stays alert | | | |

|Fidgets excessively | | | |

|Waits for turn | | | |

|Follows class rules | | | |

|Adapts to change | | | |

|Transitions easily | | | |

|Responds to familiar people | | | |

|Form attachments | | | |

|Participates in conversation | | | |

|Cooperates in a group | | | |

|Develops friendships | | | |

|Copes with frustration | | | |

Wheelchair Mobility:

Manual or Electric

| |Yes |No |Comments |

|Self propel | | | |

|Able to navigate school | | | |

|Ascend ramp | | | |

|Descend ramp | | | |

|Locks brakes | | | |

|Unlocks brakes | | | |

Sensation:

| |Yes |No |Comments |

|Accepts being touched | | | |

|Assists in personal grooming | | | |

|Touches others appropriately | | | |

|Respects space of others | | | |

|Comfortable using class materials | | | |

|Body awareness | | | |

|Moves without bumping into objects/people | | | |

|Uses a heel-toe gait pattern | | | |

|Imitates a novel movement pattern | | | |

|Incorporates visual, verbal and tactile | | | |

|information | | | |

|Stays alert during class | | | |

|Regulates reaction to stimuli | | | |

|Inhibits excessive movement | | | |

|Attends to instruction | | | |

|Adapts to unpredictable sounds | | | |

|Orients to auditory stimuli | | | |

|Makes eye contact with people | | | |

|Looks at objects | | | |

|Attends to relevant visual info | | | |

|Matches/Sorts colors | | | |

|Matches/Sorts shapes | | | |

|Identifies up, down | | | |

|Identifies under, over | | | |

|Identifies top, bottom | | | |

SUMMARY and RECOMMENDATIONS

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|Summary of Present Level of Function (summarize the student’s school-based fine motor function, outlining both strengths and weaknesses and how this may |

|impact their ability to participate in the school environment) |

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|School-Based Occupational Therapy is |

|recommended |

| | Frequency | Duration | Group | |

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|Explain how School-Based Occupational Therapy will benefit the student’s function and performance in his/her educational program (Please include suggested |

|goals/objectives): |

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|not recommended because |

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|□ the student’s needs can be met by the primary education program. |

|□ the student’s current function is at an appropriate level given the nature of his/her disability. |

|□ the student’s physical limitations or deficits do not interfere with his/her participation in the school environment. |

|□ the student’s deficits cannot be addressed by school-based occupational therapy. |

|□ others: ___________________________________________________ |

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|Other Suggestions |

Therapist’s Name: (Print)___________________ Preschool:___________________

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