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Disability Checklist for Educators

This physical and multiple disability checklist collects information about a student, including their name, grade, date, teacher, and school. It documents the causes of their disability such as brain injuries, other injuries, diagnosed conditions like cerebral palsy or muscular dystrophy, and affected areas of development. The impact at school is also noted, covering self-esteem, inclusion, learning, mobility and more. Others involved and additional details are recorded, along with planned follow up.

Uploaded by

Gheylhu Amor
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367 views3 pages

Disability Checklist for Educators

This physical and multiple disability checklist collects information about a student, including their name, grade, date, teacher, and school. It documents the causes of their disability such as brain injuries, other injuries, diagnosed conditions like cerebral palsy or muscular dystrophy, and affected areas of development. The impact at school is also noted, covering self-esteem, inclusion, learning, mobility and more. Others involved and additional details are recorded, along with planned follow up.

Uploaded by

Gheylhu Amor
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
  • General Information
  • Areas of Development Affected
  • Additional Information

Physical & Multiple Disability Checklist

Name: __________________________________________ Grade: _______________ Date: _______________

Teacher: ________________________________________ School: ___________________________________

Difficulties with both verbal and nonverbal communication, expressive and receptive communication

Cause of disability Brain injuries


Before birth
During birth
Close to birth
Other injuries
Before birth
During birth
Close to birth
Brain injuries through
Accidents
Near drowning
Electrocution
Violence / trauma
Abuse
Other injuries (e.g. spinal) through
Accident
Near drowning
Electrocution
Violence / trauma
Abuse
Injury to the mother before birth
Premature birth
Syndromes
Genetic abnormalities
Disease
Malnutrition
Progressive conditions
Other

Diagnosed conditions Cerebral palsy


Spina bifida
Rheumatoid arthritis

No Limits: Teachers including learners with disabilities in regular classrooms


Muscular dystrophy
Arthritis
Ontogenesis imperfecta
Congenital malformation of the limbs
Acquired brain injury
Cancer
Motor neurone disease
Other

Areas of development affected


Muscle tone
Muscle strength
Gross motor skills
Fine motor skills
Mobility
Communication skills
Social skills
Health
Others

Impact at school Self esteem


Social inclusion
Information processing
Receptive language
Expressive language
Problem solving
Motor planning
Memory, attention
Learning new skills and concepts
Access and participation in learning
Stamina
Continuity of attendance at school owing to health issues
Self – help skills
Other

No Limits: Teachers including learners with disabilities in regular classrooms


Others Involved

Additional information

Follow up Who / What? When?

No Limits: Teachers including learners with disabilities in regular classrooms

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