Student COMPID:__________________________________________ District:___________________________________________________

Date:____________________________________________________ School:____________________________________Grade___________
Observer:_________________________Phone:__________________ Setting:__Lunch ____Recess_____Community___Other:____________
Student’s Schedule Matches Placement Y or No Reason:___________________________________________________________________
State Department of Education Walkthrough Review
of IEP implementation, Use of Supplementary Aids and Services and Best Practices
for Students with Disabilities in NONINSTRUCTIONAL Settings
# Indicators Little or No Evidence Sufficient Evidence Score (NA)
Score pt. = 0 Score pt. = 1 0 or 1

1 Student is actively engaged in an activity or Student is alone, or with
communication with age-appropriate nondisabled peers. students with disabilities,
students several years
younger, or an adult.
Student is disinterested
and not attentive to peers.
2 Paraprofessional/job coach, if applicable, appropriately Para/job coach is
assists the student without interfering with peer assistance positioned directly next to
or developing an overdependence of the student on the the student and interferes
assistance of the paraprofessional. w/ the child’s ability to
interact w/ his/her peers.
Para/job coach answers
for, or provides the
answer to the student.
Para/job coach does not
allow other students to
assist or the child to self-
advocate for him/herself.
3 If appropriate, student is attentive to the adult (other than Student does not respond
an assigned para/job coach, if applicable) who is speaking to or acknowledge an
to the group (e.g., in an assembly or giving a direction at adult’s directions or
recess). comments.
Student is actively engaged in an
activity making eye contact, and/or
or communicating in some way
with age-appropriate peers or
community members.
Para/job coach is positioned in
close proximity to the child
allowing for free interaction with
peers. Para/job coach allows the
student to ask questions of his/her
peers, to learn by doing, or to
make a mistake which may require
the para/job coach to assist to
clarify or correct.
Student is attentive to the adult
when he/she is speaking.
Student follows the adult’s
directions or does so after clarifi-
cation from a para/coach or peer.

Total of_________ points out of _______ applicable indicators.

Pg. 1/1
NON-INSTRUCTIONAL

CSDE 4/06
Pilot