INSTRUCTIONS: Have several team members complete this form for at least five days over one week. Use a separate page for each environment that is observed. Write the environment (e.g., home, work, recreation, community, or school). Write the location of the environment (e.g., grocery store, kitchen, breakroom, PE, baseball field, etc.). List all of the activities of the student or the student's chronologically age-appropriate classmates that are done within the environment and location.
| Student's Name: |
| Date: |
| Person Completing the Form: |
| Environment: |
| Location (specify): |
| Activities:
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