Vanderbilt Assessment Form PDF Details

Are you in search of an effective tool to evaluate the performance of your employees? If so, then consider using the Vanderbilt Assessment Form. This assessment form is designed to measure various aspects of job performance, such as goal achievement, problem-solving abilities, and customer service skills. It is easy to use and provides highly reliable results that can help inform significant decisions about personnel development or placement in certain positions within your organization. In this blog post, we will delve into what the Vanderbilt Assessment Form entails and take a look at why it's such a helpful tool for employers looking to judge their staff members' efficiency. We’ll also explore some frequently asked questions about this assessment form and see how others have used it with success.

QuestionAnswer
Form NameVanderbilt Assessment Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesvanderbilt assessment teacher, vanderbilt form, vanderbilt forms, vanderbilt teacher assessment

Form Preview Example

D6

NICHQ Vanderbilt Assessment Follow-up—TEACHER Informant

 

 

TeacherÕs Name: _______________________________ Class Time: ___________________ Class Name/Period: _______________

TodayÕs Date: ___________ ChildÕs Name: _______________________________ Grade Level: ______________________________

Directions: Each rating should be considered in the context of what is appropriate for the age of the child you are rating and should reflect that child’s behavior since the last assessment scale was filled out. Please indicate the number of weeks or months you have been able to evaluate the behaviors: ___________.

Is this evaluation based on a time when the child

■ was on medication ■ was not on medication ■ not sure?

 

 

 

 

 

 

Symptoms

 

Never

Occasionally

Often

Very Often

 

 

 

 

 

 

1.

Does not pay attention to details or makes careless mistakes with,

0

1

2

3

 

for example, homework

 

 

 

 

 

 

 

 

 

 

 

2.

Has difficulty keeping attention to what needs to be done

0

1

2

3

 

 

 

 

 

 

 

3.

Does not seem to listen when spoken to directly

 

0

1

2

3

 

 

 

 

 

 

4.

Does not follow through when given directions and fails to finish

0

1

2

3

 

activities (not due to refusal or failure to understand)

 

 

 

 

 

 

 

 

 

 

 

5.

Has difficulty organizing tasks and activities

 

0

1

2

3

 

 

 

 

 

 

6.

Avoids, dislikes, or does not want to start tasks that require ongoing

0

1

2

3

 

mental effort

 

 

 

 

 

 

 

 

 

 

 

7.

Loses things necessary for tasks or activities (toys, assignments,

0

1

2

3

 

pencils, or books)

 

 

 

 

 

 

 

 

 

 

 

 

8.

Is easily distracted by noises or other stimuli

 

0

1

2

3

 

 

 

 

 

 

 

9.

Is forgetful in daily activities

 

0

1

2

3

 

 

 

 

 

 

 

10.

Fidgets with hands or feet or squirms in seat

 

0

1

2

3

 

 

 

 

 

 

 

11.

Leaves seat when remaining seated is expected

 

0

1

2

3

 

 

 

 

 

 

12.

Runs about or climbs too much when remaining seated is expected

0

1

2

3

 

 

 

 

 

 

13.

Has difficulty playing or beginning quiet play activities

0

1

2

3

 

 

 

 

 

 

 

14.

Is Òon the goÓ or often acts as if Òdriven by a motorÓ

 

0

1

2

3

 

 

 

 

 

 

 

15.

Talks too much

 

0

1

2

3

 

 

 

 

 

 

16.

Blurts out answers before questions have been completed

0

1

2

3

 

 

 

 

 

 

 

17.

Has difficulty waiting his or her turn

 

0

1

2

3

18.

Interrupts or intrudes in on othersÕ conversations and/or activities

0

1

2

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Somewhat

 

 

 

 

Above

 

of a

 

Performance

Excellent

Average

Average

Problem Problematic

19.

Reading

1

2

3

4

5

 

 

 

 

 

 

 

20.

Mathematics

1

2

3

4

5

 

 

 

 

 

 

 

21.

Written expression

1

2

3

4

5

 

 

 

 

 

 

 

22.

Relationship with peers

1

2

3

4

5

 

 

 

 

 

 

 

23.

Following direction

1

2

3

4

5

 

 

 

 

 

 

 

24.

Disrupting class

1

2

3

4

5

 

 

 

 

 

 

 

25.

Assignment completion

1

2

3

4

5

 

 

 

 

 

 

 

26.

Organizational skills

1

2

3

4

5

 

 

 

 

 

 

 

The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circum- stances, may be appropriate.

Copyright © 2005 American Academy of Pediatrics, University of North Carolina at Chapel Hill for its North Carolina Center for ChildrenÕs Healthcare Improvement, and National Initiative for ChildrenÕs Healthcare Quality

Adapted from the Vanderbilt Rating Scales developed by Mark L. Wolraich, MD.

Revised - 0303

D6 NICHQ Vanderbilt Assessment Follow-up—TEACHER Informant, continued

TeacherÕs Name: _______________________________ Class Time: ___________________ Class Name/Period: ________________

TodayÕs Date: ___________ ChildÕs Name: _______________________________ Grade Level: ______________________________

Side Effects: Has the child experienced any of the following side

Are these side effects currently a problem?

 

 

 

 

 

effects or problems in the past week?

None

Mild

Moderate

Severe

 

 

 

 

 

Headache

 

 

 

 

Stomachache

 

 

 

 

 

 

 

 

 

Change of appetiteÑexplain below

 

 

 

 

 

 

 

 

 

Trouble sleeping

 

 

 

 

 

 

 

 

 

Irritability in the late morning, late afternoon, or eveningÑexplain below

 

 

 

 

 

 

 

 

 

Socially withdrawnÑdecreased interaction with others

 

 

 

 

 

 

 

 

 

Extreme sadness or unusual crying

 

 

 

 

 

 

 

 

 

Dull, tired, listless behavior

 

 

 

 

 

 

 

 

 

Tremors/feeling shaky

 

 

 

 

Repetitive movements, tics, jerking, twitching, eye blinkingÑexplain below

 

 

 

 

 

 

 

 

 

Picking at skin or fingers, nail biting, lip or cheek chewingÑexplain below

 

 

 

 

 

 

 

 

 

Sees or hears things that arenÕt there

 

 

 

 

Explain/Comments:

 

 

 

 

For Office Use Only

Total Symptom Score for questions 1Ð18: ____________________________________

Average Performance Score: ______________________________________________

Please return this form to: ________________________________________________________________________________________________________

Mailing address:__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________

Fax number: __________________________________________________________________________________________________________________________________________________________

Adapted from the Pittsburgh side effects scale, developed by William E. Pelham, Jr, PhD. Available for downloading at no cost in expanded format at http://wings.buffalo.edu/adhd

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