Occupational Therapy Observation Request

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Please use this to request an OT student observation

School *

Student's Last Name *

Student's First Name *

Teacher *

Grade *

Area(s) of Concern *

Fine Motor (pencil grasp, manipulatives, handwriting, cutting)

Independence skills (clothing fasteners, following self-care routines, organization of materials)

Sensory Regulation (seeks or avoids movement, difficulty with sound, texture, personal space, body awareness)

Other:

Required

Scheduling: When is the student in specials? *

When will the SST meet again regarding this student?

Problem Solving: Please share interventions tried (ie: use of OT/PT Intervention Toolkit strategy) and their outcome.

Submit

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