Student Risk Assessment Form
Use this form to assess student risk factors and record observations, concerns, and follow-up needs. The form is designed for school or academic support use.
Student Information
Student Name
*
First Name
Last Name
Grade / Year Level
*
Please Select
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Other
School / Class / Section
*
Risk Assessment
Current Attendance Pattern
*
Regular
Occasional Absences
Frequent Absences
Chronic Absence
Academic Performance Concern Level
*
Low Concern
1
2
3
4
5
6
7
8
9
High Concern
10
1 is Low Concern, 10 is High Concern
Behavioral Concern Frequency
*
1
2
3
4
5
Observed Emotional / Engagement Level
*
Low
1
2
3
4
5
6
7
8
9
High
10
1 is Low, 10 is High
Risk Factors
*
Follow-up Notes
Notes / Observations
Recommended Follow-up Level
*
Monitor
Schedule meeting
Refer for support
Urgent review
Submit
Should be Empty: