Social Skills Assessment:

Name:________________________ Teacher:__________________
Instructional Period: __________________-________________
Basic Social Skills: Baseline: Initiated: Acquired:
Orients body to speaker
Orients head to speaker
Maintains orientation to speaker for __ turn
conversation
Makes eye contact with speaker
Maintains eye contact/ Makes Eye Contact a
minimum of __ times within conversation
Maintains appropriate distance from
speaker (approx. 3-5 feet)
Approaches speaker & stands at
appropriate distance
Speaks at appropriate pace and/or
repeats slowly when asked
Speaks at appropriate volume and/or
repeats at appropriate volume when asked
Participates in appropriate physical
interactions (e.g., hand shake, high five, fist
pound, etc.)

Notes:

Page: __________-_________
 Social Skills Assessment:
Name:________________________ Teacher:__________________
Instructional Period: __________________-________________
Conversational Skills: Baseline: Initiated: Acquired:
Responds to greetings (e.g., Hello, Hi, etc.)
Responds to farewells (e.g., Bye, See you
later, etc.)
Responds to basic social questions (e.g.,
What’s up? How are you? etc.)
Responds to & reciprocates social
questions (e.g., I’m fine, how are you?)
Takes conversational turns (Waits for turn
to speak)
Responds to basic social, recall & personal
info questions with own/accurate info
(Does not just repeat others’ answers)
Listens to & recalls information from a
speaker (e.g., Answers “What did __ do last
night?” after peer tells group about night.)
Asks follow up questions
Makes comments
Maintains topic of conversation
Changes topic appropriately
Ends conversation appropriately

Notes:

Page: __________-_________
 Social Skills Assessment:
Name:________________________ Teacher:__________________
Instructional Period: __________________-________________
Game Playing Skills: Baseline: Initiated: Acquired:
Responds to peer invitation to join game
Invites peer to play a game
Asks to join others’ game
Asks peers to play desired game / have
desired piece / take first turn
Accepts “no” / makes compromises / allows
others to choose (game, color of piece, etc.)
Helps set up game
Waits for turn
Takes single turn appropriately
Moves own piece (Recalls & uses own color)
Accepts loss
Congratulates winner
Shows good sportsmanship when winning
(e.g., tells peers “Good Game”)
Helps clean up game

Notes:

Page: __________-_________