Social Skills Checklist (secondary)

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Rating Scale

Rating Scale
Almost always- the student consistently displays this skill in many settings and with a variety of people
Often- the student displays this skill on a few occasions, settings and with a few people
Sometimes- the student seldom displays this skill but may demonstrate it on infrequent occasions
Almost Never- the student never or rarely exhibits this skill. It is uncommon to see this in their daily routine.

Date *

YYYY

Student Full Name *

Who is Filling out this survey? *

Mother

Father

Teacher

Teacher's Name

1. Conversational Skills (Verbal and Non-Verbal) *

Almost Always

Often

Sometimes

Almost Never

Initiate conversation when it is appropriate to do so

Initiates conversation around specific topic

Asks “Wh” questions

Makes a variety of comments, related to the topic

Introduces him/herself to someone new

Introduces people to each other

Ends conversations appropriately

Waits to interject in a conversation

Maintains appropriate proximity to conversation partner

2. Problem Solving *

Almost Always

Often

Sometimes

Almost Never

Seeks help from peers

Seeks help from adult

Plays a game successfully

Identifies/defines problems

Generates solutions to problems

Carries out solutions by negotiating or compromising

Understands impact his/her behavior has on peers

3. Understanding Emotions *

Almost Always

Often

Sometimes

Almost Never

Identifies likes and dislikes

Identifies emotions in self

. Identifies emotions of others

Justifies emotions once identified (eating because I’m hungry)

Demonstrates affection and empathy toward peers

Refrains from aggressive behaviors toward peers

Refrains from aggressive behaviors toward self

Does not exhibit intense fears or phobias

Interprets body language

Uses different tones of voice to convey messages

Almost Always

Often

Sometimes

Almost Never

Identifies likes and dislikes

Identifies emotions in self

. Identifies emotions of others

Justifies emotions once identified (eating because I’m hungry)

Demonstrates affection and empathy toward peers

Refrains from aggressive behaviors toward peers

Refrains from aggressive behaviors toward self

Does not exhibit intense fears or phobias

Interprets body language

Uses different tones of voice to convey messages

4. Compliments *

Almost Always

Often

Sometimes

Almost Never

Appropriately receives compliments

Asks for a favor appropriately

Apologizes independently

Says thank you

Gives compliments to peers

Gives compliments to adults

5. Flexibility *

Almost Always

Often

Sometimes

Almost Never

Accepts making mistakes without becoming upset/angry

Accepts consequences of his/her behavior

Apologizes independently

Accepts unexpected changes

Continues to try when something is difficult

Ignores others or situations when it is desirable to do so

Any additional information you'd like to share about the student's social emotional needs. *

Are you interested in your child receiving counseling services ? *

Yes and I would like the school counsoler to contact me.

No thank at this time.

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