Sensory Screening Request and Data Collection Form

Sensory Screening Request and Data Collection Form


From The Organizing OT, this product is a sensory screening request form designed to engage the classroom teacher in the process. As part of a Response to Intervention process, this form focuses on sharing knowledge and building relationships so that students can have their needs met in the least restrictive environment. 

This download also includes two different sheets for recording data. One is designed to be utilized during up to 10 observations, and includes date, time, setting, and a space for comments. The other is a 6 week calendar, which allows for data on sensory behaviors and progress to be recorded quickly and easily, using an Environment coding systems. Three weeks are to be completed pre-intervention, and 3 weeks are to be completed with the introduction of sensory strategies, activities, or tools.

  • Digital Download: Please download within 24 hours of accessing link
  • Pages: 4
  • Format: PDF
  • Created in 2013

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About the Creator

Heather Brohm is a graduate of Boston University and an occupational therapist with more than 5 years of experience in the schools. In addition to her work as an OT, she has had many other opportunities to learn from children, both professionally and personally.  Her professional interests include child development, transition, and evidence-based practice. 

As with all of The Organizing OT products, Heather welcomes feedback and hopes that you are satisfied with your purchase! Please feel free to contact her with any questions, concerns, or suggestions!


Products by Heather Brohm are licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 Unported License.

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