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Tiered Checklist

This document appears to be an observation form used to assess the tiered supports provided in a classroom. It includes checkboxes to indicate whether Tier 1, 2, and 3 supports are implemented. Tier 1 supports focus on whole class supports like clear expectations and procedures. Tier 2 supports involve some small group and individual supports like differentiated assignments and check-ins. Tier 3 supports are highly individualized and intensive, including individual schedules, assistive technology, and behavioral or mental health plans. The form is used to document what supports are in place to meet the varied needs of students in the classroom.

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45 views1 page

Tiered Checklist

This document appears to be an observation form used to assess the tiered supports provided in a classroom. It includes checkboxes to indicate whether Tier 1, 2, and 3 supports are implemented. Tier 1 supports focus on whole class supports like clear expectations and procedures. Tier 2 supports involve some small group and individual supports like differentiated assignments and check-ins. Tier 3 supports are highly individualized and intensive, including individual schedules, assistive technology, and behavioral or mental health plans. The form is used to document what supports are in place to meet the varied needs of students in the classroom.

Uploaded by

api-658863187
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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School: ________________________ Date: __________________ Time: ______________________

Grade Level Observed: __________________ Teacher: _________________

Tier 1 Tier 2 Tier 3


☐Classroom set up – space available for teacher ☐A space is designated in the classroom for small ☐Individual reward system for a child (Menu
to access all students. group work reward system, differentiated monitoring tools)

☐Student break area ☐Differentiated assignments- one group may ☐1:1 frequent checks with one child for
have modifications/ accommodations understanding
☐Expectations posted positively
☐Strategically placed students by peer models ☐Focused and individualized check in for a
☐Expectations referenced by the teacher student. (social goals)
☐Teacher goes back over behavioral expectations
☐Visual class incentives for a small group of students ☐Individualized work (broken into manageable
chunks, reduced level of reading, accessing
☐Noise impact – voice levels referenced/ posted ☐Several students have a sticker chart or reward technology for support, read aloud to the student)
system beyond the classroom incentive
☐Organized student materials ☐Student has individual schedule on desk
☐Several students have reminders of changes to
☐Procedures for transitions (last less than 2 min) schedule ☐Student may use assistive technology to support
writing and reading (clicker 7, snap and read)
☐Materials prepared ☐Several students have check ins with adults
throughout the day (Check in/ Check out) ☐Behavior Plan (AIM)
☐Attention signal “123 eyes on me”
☐Sensory tools utilized for certain students ☐Other resources are available for the student:
☐Class schedule visible and referenced wrap around, mental health services, special
☐Use of wiggle chairs, rocking stools education, etc.
☐Students provided regular opportunities to
respond ☐Teaching relaxation skills (gonoodle, mind yeti)

☐Acknowledging positive behavior ☐Structured breaks

☐Using Second Step language ☐Non-verbal cues and signals

☐Forced choice/ First-Then

Sources: National PBIS, PBIS World

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