Autism Communication Log Form
Use this form to record observations and support notes related to communication patterns for individuals with autism.
Observer Name
*
First Name
Last Name
Date of Observation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Individual’s Name or Initials
*
Communication Method
*
Please Select
Verbal
Nonverbal (gestures, facial expressions)
Augmentative/Alternative Communication (AAC)
Written
Other
Context or Situation
*
Observed Communication Behaviors
*
Initiates communication
Responds to communication
Uses eye contact
Uses gestures
Repeats words/phrases
Other
Possible Triggers or Antecedents
Support Strategies Used
*
Visual supports
Prompting
Modeling
Wait time
Positive reinforcement
Other
Outcome or Effectiveness
*
Please Select
Effective
Partially effective
Not effective
Not observed
Additional Notes
Submit Log
Should be Empty: