Child Emotional & Social Well-Being In School Questionnaire

To be completed by a teacher or other appropriate member of staff

Child’s Name: DOB:

Please complete this form to help describe the emotional and social well-being of
the child as they present in a school/class setting. The information will be treated
confidentially and be used to help identify needs and appropriate actions.
Please circle one box for each question:

The child appears to be mostly happy at school?

Strongly Agree 1 2 3 4 5 Strongly Disagree

The child presents as socially confident?

Strongly Agree 1 2 3 4 5 Strongly Disagree

The child appears to have good relationships with their peers?

Strongly Agree 1 2 3 4 5 Strongly Disagree

The child appears to have friends at school?

Strongly Agree 1 2 3 4 5 Strongly Disagree

The child quickly ‘bounces back’ from upsets and difficulties?

Strongly Agree 1 2 3 4 5 Strongly Disagree

Is there anything that makes this child appear anxious or upset in school?

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