We have been asked to do a visual assessment on this child. As visual development and general development are inter-related, it would be helpful to our assessment if you could fill in the following questionnaire on your observations.
Child’s Information (Confidential)
Teachers usually have had the opportunity to observe the child in different situations and note any difficulty. The following is a checklist of symptoms which have been found to be frequently associated with a vision problem. Please read through this list and check those items you have noticed in this child's case.
WRITING OR OTHER DESK TASKS
APPEARANCE OF EYES
BODY POSTURE AND SPACE AWARENESS