MOTOR SCREENING TOOL

New Hanover County Schools

STUDENT NAME: __________________________________

DOB: _____________

SCHOOL: _________________________________________

DOS: _____________

Instructions: Complete sections A, B and C. Circle either Yes or No beside each item based on your observations of
this student in the classroom, lunchroom, bathroom, moving between classes and on the playground.
A. When compared to their peers, in their age category, in their educational setting, does the student demonstrate the
ability to:
Yes
No
Access all areas of campus, classroom, and materials
Yes
No
Open/close containers
Yes
No
Hold scissors to cut
Yes
No
Hold a writing tool to draw/write
Yes
No
Show a hand preference
Yes
No
Use a variety of grasp patterns, including 2-point and 3-point grasp
Yes
No
Access/pick up/carry/put down items (e.g., lunch tray, backpack, etc.)
Yes
No
Use utensils to feed themselves
Yes
No
Get up and down from the lunch table
Yes
No
Pull up/down their pants when using the bathroom
Yes
No
Wash/dry their hands
Yes
No
Safely negotiate stairs/curbs and move between classes
Yes
No
Open/close doors
Yes
No
Walk, run, and play without excessive falls
Yes
No
Move quickly with change in direction without loss of balance
Yes
No
Motor plan activities such as catch, throw, kick or avoid obstacles
Yes
No
Play/climb on playground equipment
B. Seems to have typical posturing of body parts, typical movement patterns, and steady hand
Yes
No
movements
C. Physical endurance commensurate with peers for an entire school day
Yes
No
Notes:
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All YESs - student has functional gross and fine motor skills to access the school environment
Some NOs - determine to what extent deficits are impacting students education and consider interventions
All NOs - assess the extent of impact on the students education and determine next steps
Next Steps

Student demonstrates ability to access educational environment

Student may benefit from guided practice in gross motor skills
Student may benefit from guided practice in fine motor skills
Student requires additional assessment

COMPLETED BY _______________________________________________________DATE____________
(CHECK ONE)
PSYCHOLOGIST
PERSONS CONSULTED TO OBTAIN INFO:
SPECIAL EDUCATION TEACHER
___________________________________
OCCUPATIONAL THERAPIST
___________________________________
PHYSICAL THERAPIST
___________________________________
HEALTH PROFESSIONAL

NHCS Motor Screening

03.13.12