Teacher/SENCo Questionnaire

 

    Your Name:

    Position (SENCo/Teacher):

    Child's Name:

    Child's Date of birth:

    Occupational Therapy assessment explores whether there are any sensory or motor skills differences impacting upon a child’s participation at home or school. It would be very helpful if you could answer the following questions to provide us with more information about the child’s needs and how these present at school.

    1. Does the child have an EHCP? YesNo

    2. Has an application been made for a EHC needs assessment? YesNo

    3. Does the child receive any additional support at school? e.g. 1:1 Teaching Assistant support, small group support etc. YesNo

    4. If yes to the above question, please provide details:

    5. Do you have any concerns about the child’s gross motor (large movement) skills e.g. climbing stairs, running, jumping, hopping, participation in PE? YesNo

    6. If yes to the above question, please provide details:

    7. Do you have any concerns about the child’s fine motor skills e.g. manipulating small objects, handwriting, scissor skills? YesNo

    8. If yes to the above question, please provide details:

    9. Do you have any concerns about the child’s independence e.g. changing for PE, toileting and using cutlery at lunchtime? YesNo

    10. If yes to the above question, please provide details:

    11. Do you have any concerns about the child’s sensory processing e.g. attention for learning, ability to cope with the school environment, tolerance of large group activities such as playtime, assembly, the dining hall etc? YesNo

    12. If yes to the above question, please provide details:

    13. Please provide any additional information that you think would be helpful for us to know:

    Thank you very much for your time in answering the above questions.