Behavioral Observation and Learning Inventory (BOLI) Questionnaire Form
Please complete this inventory to document behavioral observations and learning characteristics. Your responses will support individualized learning strategies.
Your Full Name
*
First Name
Last Name
Your Role/Relationship to the Observed Individual
*
Please Select
Teacher
Parent/Guardian
Counselor
Specialist
Other
Date of Observation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Observation Setting
*
Please Select
Classroom
Playground
Home
Therapy Room
Other
Observed Individual's First Name or Identifier
*
Level of Engagement During Activities
*
1
2
3
4
5
Response to Instruction or Guidance
*
Rarely Responsive
1
2
3
4
Highly Responsive
5
1 is Rarely Responsive, 5 is Highly Responsive
Ability to Work Independently
*
Needs Constant Support
1
2
3
4
Fully Independent
5
1 is Needs Constant Support, 5 is Fully Independent
Learning Strengths Observed
Verbal Communication
Social Skills
Problem Solving
Creativity
Attention to Detail
Other
Areas of Challenge or Support Needs
Submit
Should be Empty: