Kelas:
Haribulan:
Isnin
Selasa
Rabu
Khamis
Jumaat
9.00-9.30
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9.30-10.00
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10.4012.00
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JUMLAH
10
14
11
Rehat
Pemerhati: ....................................................................................................
Tarikh pemerhatian :.....................................................................................
Masa pemerhatian : .....................................................................................
Nama pelajar : .............................................................................................
Penerangan tentang kejadian:
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Penerangan tentang lokasi/ latar belakang kejadian :
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Nota, cadangan dan langkah:
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Nama Murid :
Masa Mula
Sela
Masa
: 8.00 pagi
Nam
a
muri
d
Siti
Ali
Nur
/
/
/
/
/
/
/
/
/
Nama Murid : .
Jantina : L / P
Agresif
Pasif
Kognitif
Emosi
Negatif Sosial
Motor Kasar
Motor Halus
Pertuturan
Pengurusan Diri
Tertib Makan
(
(
)
)
Nama : .............................................................................
No K/P : ...........................................................................
Alamat : ..........................................................................
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Tandatangan: .......................
Tarikh: ..........................
Waqi ahmad
: 07.09.2000
Kelas
: 3 Sinar
Tarikh
: 21 0gos 2009
Onset
Offset
Onset
Offset
Nama
murid
Maria
9.00-9.05
9.06-9.15
9.16-9.20
9.20-9.30
Syafiq
9.00- 9.08
9.09- 9.20
9.21- 9.25
9.26- 9.30
Auni
9.00-9.04
9.05- 9.10
9.11- 9.15
9.16- 9.30
Onset
Offset
Onset
Nama murid:
Tarikh Lahir :
Kelas
Penilai
Aktiviti
Masa
8.00 pg
9.00 pg
10.00 pg
11.00pg
12.00 tghri
1.00 tghri
2.00 ptg
Duduk
Tempat
Diri
Goyang
Dapur
Bilik
tamu
Bilik
tidur
Ulasan
Nama Murid : .
Jantina : L / P
Agresif
Pasif
Kognitif
Emosi
Negatif Sosial
Motor Kasar
Motor Halus
Pertuturan
Pengurusan Diri
Tertib Makan
(
(
)
)
Nama : .............................................................................
No K/P : ...........................................................................
Alamat : ..........................................................................
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Tandatangan: .......................
Tarikh: ..........................
Bil
Perlakuan Agresif
1.10Merosakkan harta sendiri/ orang lain
1.11Selalu berkelahi/ bertindak
1.12Cepat marah/ meradang
1.13Mengacau/ Menguasai orang lain
1.14Mencederakan diri
1.15Mencederakan orang lain
1.16Panas baran
1.17Perlakuan negatif berlaku dengan tiba-tiba
1.18Hiperaktif
Perlakuan Pasif
2.1 Memencilkan diri
2.2 Sugul
2.3Terlalu pendiam
2.4 Terlalu malas
2.5 Mudah terganggu perhatian
2.6 Terlalu malu
2.7 Lembab pergerakan
2.8 Lembab membuat sesuatu
Ulasan
Pemasalahan Emosi
4.1 Gelisah
4.2 Menggerakkan bahagian anggota badan tanpa dapat dikawal
4.3 Bebal
4.4 Menipu / berbohong
4.5 Selalu mengadu sakit
4.6 Menangis dalam kelas
4.7 Memerlukan perhatian yang lebih
4.8 Risau
4.9 Berkhayal/ termenung
4.10 Membuat sesuatu tanpa tujuan