CLASSROOM ADAPTATIONS CHECKLIST FOR STUDENTS WITH
PHYSICAL, HEALTH, OR MULTIPLE DISABILITIES, 3rd Edition
Georgia State University, Kathryn Wolff Heller, Ph.D., 2008
1. Student Information
Name: Date of birth: Educational placement:
Type of disability: Restrictions (e.g., activity, diet, allergies):
Mobility: Communication:
2. Physical/Health Monitoring
____ Monitor for health problems (e.g., seizure, asthma, shunt malfunction)
____ Monitor for a decline in motor ability or mobility (e.g., falls, difficulty writing)
____ Monitor for need for repositioning
____ Monitor for pressure sores (pressure ulcers)
____ Monitor for pain and discomfort
____ Monitor for fatigue and low endurance
____ Monitor for medication and treatment effects (including healthcare procedures)
____ Other:
Description and actions to take for checked areas:
3. Environmental Arrangement: Across School Environments and Scheduling
____ Modified day
____ Transportation (bus) modifications
____ Arrival/departure issues
____ School navigational issues (e.g., requires elevator, railings, help with stairs or ramps)
____ Leaves early for next class (specify how early)
____ Close proximity of classrooms needed
____ Classrooms must be near an exit
____ Locker adaptations needed
____ Assistance needed with putting on or taking off outer clothing
____ Bathroom adaptations or assistance needed
____ Lunchroom adaptations or eating assistance required
____ Playground adaptations or assistance needed
____ Assembly adaptations
____ Specialized emergency evacuation plan
____ Scheduling adaptations needed (e.g., trip training, health care procedures, positioning) ____ Other:
Description and actions to take for checked areas:
4. Environmental Arrangement: Within Classrooms
____ Widened aisles needed
____ Assistance needed in mobility
____ Assistance needed in getting into or out of a chair, or moving chair up to desk
____ Preferential seating required
____ Special chair, desk, other
____ Work surface adaptations needed (e.g., slant, height)
____ Materials need to be stabilized
____ Materials specially positioned (e.g., location, spacing, target size)
____ Assistance manipulating materials (e.g., alternate access, modify material)
____ Scheduled rest breaks or rest breaks as needed (specify when, how long)
____ Other:
Description and actions to take for checked areas:
5. Communication
____ Uses AAC (specify type)
____ Reliable Means of Response: _______________________________
____ Communicates correct answer with multiple choice format
____ Longer time to respond (specify length)
Description and actions to take for checked areas:
6. Areas Needing Adaptations and Assistive Technology
____ Computer adaptations needed for access
____ Writing or keyboarding
____ Spelling
____ Reading
____ Math
____ Specific content areas_______________ (Specify)
____ Life management/daily living
____ Recreation or leisure
____ Physical Education
____ Prevocational areas
____ Specials (art, music)
____ Other areas:
Description and actions to take for checked areas:
7. Class Participation
____ Dependent upon teacher to prompt participation
____ Give student question(s) to answer in advance
____ Uses modified response/ communication system
____ Gains teacher attention by: ___ raising hand, ____ signally device, ___ AAC system.
____ Works best: __individually, ___ peer, ___ small group, ___ large group
____ Other:
Description and actions to take for checked areas:
8. Instruction and Curricular Adaptations
____ Modified curriculum (e.g., lower grade level, adapted curriculum, Direct Instruction)
____ Benefits from antecedent prompts (e.g., highlighting relevant feature, modeling, sample)
____ Benefits from preview types of strategies (e.g., advance organizers)
____ Benefits from response prompt strategies (e.g., time delay, least prompts)
____ Benefits from learning strategies (e.g., mnemonics, key words, song)
____ Benefits from student directed strategies (e.g., self-monitoring and recording, self-talk)
____ Requires teacher reinforcement or more feedback
____ Provide extra repetition
____ Directions should be: ____ written down, ____read orally, ___demonstrated
____ Modify activity (e.g., more time, shorter segments, different response, different outcome)
____ Modify material (e.g., lower grade level, modified books for access)
____ Requires note taker and/or lectures recorded
____ Requires textbook on CD
____ Requires extra set of books
____ Requires additional personnel support
____ Requires implementation of behavioral plan
____ Other:
Description and actions to take for checked areas:
9. Assignments and Tests
____ Needs an assignment notebook or organizational binder
____ Abbreviate assignments/tests
____ Requires study guide
____ Break up assignments/tests into shorter segments
____ Provide extended time
____ Reduce paper/pencil tasks
____ Allow computer use for assignments
____ Allow alternate responding
____ Alternate test/assignment format (e.g., word bank on test, multiple choice format)
____ Omit or use alternate for physical activities (e.g., coloring, cutting, building project)
____ Peer helper for assignments :
____ Alternate grading needed
____ Other:
Description and actions to take for checked areas:
10. Sensory & Perceptual Adaptations
____ Need to decrease visual clutter
____ Needs extra lighting or low lighting
____ Needs material to be high contrast
____ Materials need to be modified visually or tactually (specify font type & size)
____ Student uses a LVD (low vision device), CCTV, other
____ Student needs everything described orally
____ Student uses hearing aides or cochlear implants, or other devices
____ Student requires adapted environment (e.g., sound absorbing material on floor, walls)
____ Student requires visual presentation
____ Student requires an interpreter
____ Student requires class notes in appropriate format
____ Other:
Description and actions to take for checked areas:
OTHER:
Name of Person Completing Checklist: ______________________________
Title: __________________________ Date: ______________________