Seated Balance Assessment Form
Complete this form to record and evaluate seated balance using standardized assessment criteria.
Participant Identifier
*
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor Name
*
Seated Posture Alignment
*
Upright and symmetrical
Slightly asymmetrical
Significantly asymmetrical
Other
Static Seated Balance (Maintains upright sitting without support for 30 seconds)
*
1
2
3
4
5
Dynamic Seated Balance (Reaches forward and returns to upright)
*
1
2
3
4
5
Ability to Reach Sideways (without losing balance)
*
Rows
Left
Right
Stable
1
2
Requires minimal support
3
4
Requires moderate support
5
6
Unable
7
8
Ability to Turn and Look Over Shoulder
*
Independent
Needs verbal cues
Needs physical assistance
Unable
Recovery from Loss of Balance (Can recover independently if balance is challenged)
*
1
2
3
4
5
Additional Comments or Observations
Submit Assessment
Should be Empty: