Attention Test Observation Form
Record and assess participant performance during an attention test session.
Observer's Full Name
*
First Name
Last Name
Participant's Full Name
*
First Name
Last Name
Participant's Age
*
Date and Time of Observation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Type of Attention Test Administered
*
Please Select
Continuous Performance Test (CPT)
Digit Span Test
Stroop Test
Trail Making Test
Other
Observed Attention Behaviors
*
Rows
Never
Rarely
Sometimes
Often
Always
Maintains focus on task
1
2
3
4
5
Responds promptly to instructions
6
7
8
9
10
Avoids distractions
11
12
13
14
15
Completes tasks without reminders
16
17
18
19
20
Demonstrates sustained attention
21
22
23
24
25
Number of Errors or Lapses Observed
*
Level of Prompting Required
*
None
Minimal
Moderate
Frequent
Overall Attention Performance Rating
*
1
2
3
4
5
Additional Comments or Observations
Submit Observation
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