Fine/Gross Motor Skill Rating Scale

Observer: Hannah Webb

Date: 12/5/16
Start Time: 10;40
Stop Time: 10;48
Name of Child: Samantha Sessoms
Age: 4 48 motnhs Birth date: 11/12/2012

Select one student. Find out their birthday. Using their birthday, create a list of fine and gross motor skills using the appendix in the back of your
book. You should select 5 fine motor skills and 5 gross motor skills. Interact with the students to rate them on the skills listed.

Skills Never Sometimes Usually Always

Fine Motor Skills

1. Completes simple puzzles *

2. Traces a diamond *

3. Wiggles thumb *

4. Copies a cross *

5. Folds paper in imitation *

Gross Motor Skills

6. Balances on one foot for 8 seconds *

7. Catches a beanbag while standing *

8. Catches a bounced ball with hands *

9. Walks toe to heel for four steps *

10. Performs 1 to 3 hops on one foot *