Gross Motor Skills Checklist Form
Use this form to record and review gross motor skill observations for each session.
Session Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Observer Name
*
First Name
Last Name
Participant Name
*
First Name
Last Name
Gross Motor Skills Checklist
*
Walks independently
Runs with coordination
Jumps with both feet
Climbs stairs with alternating feet
Throws a ball overhead
Catches a large ball
Balances on one foot
Other (please specify)
Overall Gross Motor Skill Level
*
Needs Support
1
2
3
4
Proficient
5
1 is Needs Support, 5 is Proficient
Session Notes
Submit Checklist
Should be Empty: