Manual Dexterity Assessment
Please complete this form to assess manual dexterity skills. Fill out all sections as accurately as possible.
Participant Name
*
First Name
Last Name
Participant Age
*
Gender
Male
Female
Non-binary
Prefer not to say
Dominant Hand
*
Right
Left
Ambidextrous
Relevant Medical History (e.g., injury, neurological conditions)
Manual Dexterity Task Performance
*
Rows
Task Completed
Time Taken (seconds)
Accuracy (1-5)
Pegboard Test
1
1
2
3
4
5
Threading Beads
2
1
2
3
4
5
Buttoning Buttons
3
1
2
3
4
5
Turning Screws
4
1
2
3
4
5
Assessor's Comments and Observations
Submit Assessment
Should be Empty: