Request an Assessment
Who Are We?
What do we do?
Comprehensive Psychological Assessment
Autism Spectrum Disorder Assessment
PALS Preschool/Creche Report Form
PALS Primary/Secondary School Teacher Report Form
DPO & Privacy Statement
Where are we?
Preschool/ Creche name, address and telephone number.
Name and position of person completing this form
Childs initials and date of birth
How long have you known this chld?
How many sessions per week does child attend?
How long has child attended?
1. Co-Ordination Skills: a) Describe childs gross motor skills (e.g. walking, running, crawling, climbing, rolling, jumping, hopping, kicking and catching a ball, directional throwing, etc...
1. Co-Ordination Skills: b) Fine Motor Skills (Pincer Grasp with beads, blocks, scissors control, threadint, formboards, jigsaws, shape sorters, etc...)
1. Co-Ordination Skills: Drawing skills
1. Co-Ordination Skills: Crayon/pencil grasp
2. Play Skills: Level of play (E.g. Solitary/Parallel/Co-operative, etc)
2. Play Skills: Pretend play (e.g. cars, dolls, roleplay, etc...)
3. Socialization Skills. How does this child interact with other adults/peer (e.g. turn-taking, sharing, etc)
4. Speech and Language Skills: a) By what means does the child communicate his/her needs (e.g. verbal gestures)
4. Speech and Language Skills: b) Please give an example of the words/sentences used by the child (if applicable)
4. Speech and Language Skills: c) Have you an concerns about this child's understanding of language used in the pre-school? If so, how does this affect his/her participation in the group?
4. Speech and Language Skills: d) Have you ever been worried about his/her hearing?
5. Self Help Skills. Briefly outline this child's dependence/indepencence in your preschool in the areas of (a) Toilet Skills (b) Feeding Skills (c) Dressing/Undressing skills
6. Please describe this childs general behaviour.
7. a) Has this child any specific interests? E.g. activities, books, cars, music, games, etc.
7. b) Are any of these intersts seems to be overly restrictive and/or repetitive?
8. a) How much adult supervision is needed for this child to complete a task.
8. b) How much can he/she concentrate on any one activity.
Have you any specific concerns regarding this child? E.g. attention, concentration, listening skills, or other concerns.
Thank you for the time take to complete this form. Please provide any feedback here regarding the construction/contents of this form as we continuosly look to improve our service.