Assessment of the School Situation – Student with Visual Impairment

Completed by a Teacher of Students with Visual Impairments (TVI) in collaboration with the classroom teacher, parents/guardians, and, where appropriate, the student.

Section 1: About the Student and the School

1. Student’s Name ^*

2. Age

3. Grade

4. School

5. Date of Assessment ^*mm/dd/yyyy

6. Who is present? Classroom teacher Special education teacher Parent(s)/Guardian(s) Student Teaching assistant Principal Other

7. Who requested the assessment?

8. Eye diagnosis / Visual diagnosis

9. How does the diagnosis affect the student’s functional vision?Examples: visual acuity, visual field, light sensitivity, contrast sensitivity, Cerebral Visual Impairment (CVI)

10. At what distance does the student see best? Near distance Far distance Both Don’t know

Section 2: Classroom Environment

11. Describe the classroom layout

12. Where is the student seated?Distance to the board, windows, teacher, and classmates

13. Is the seating position appropriate? Yes No Partly

14. Number of students in the class

15. Is there enough space for assistive devices? Yes No Partly

Section 3: Lighting and Visual Conditions

16. How are the lighting conditions?

17. Is there glare from windows or lighting? Yes No Sometimes

18. Can the lighting be adjusted?Blinds, curtains, dimmers Yes No Partly

19. Are there good visual contrasts in the classroom? Yes No Partly

20. Is the board easy to see? Yes No Partly

Section 4: Teaching and Learning

21. Type of board Interactive whiteboard Traditional whiteboard/blackboard Both

22. Are markers with good contrast and sufficient thickness used? Yes No Sometimes

23. How often is information written on the board? Often Sometimes Rarely

24. Is everything written on the board read aloud? Always Sometimes Rarely Never

25. Are videos and presentations displayed with adequate size and contrast? Yes No Sometimes

Section 5: Digital Learning

26. Device used PC iPad Chromebook Other

27. Which software programs and learning platforms are used?

28. Are digital learning materials adapted to the student’s needs? Yes No Partly

29. Is wireless internet access and electrical power available at the student’s workstation? Yes No

30. Are Teams, Feide, Showbie, or other digital platforms used?

Section 6: Assistive Technology

31. Assistive devices currently used Video magnifier (CCTV) Electronic magnifier Screen magnification software Screen reader CCTV/document camera Filter glasses Optical aids Braille writer Refreshable Braille display No assistive devices yet

32. Is there a need for additional assistive technology? Yes No Don’t know

33. Is there sufficient space for the assistive devices at the student’s desk? Yes No Partly

34. Who needs training? Teacher Student Teaching assistant No training needed

Section 7: Mobility and Orientation

35. Does the student change classrooms during the school day? Yes No Sometimes

36. Can the student independently find their way between classrooms? Yes No With assistance

37. Are there stairs, long corridors, or other environmental challenges?

38. Are stairs and level changes clearly marked with contrasting colors? Yes No Partly

Section 8: Teachers, Staff and Social Participation

39. Do the teachers have knowledge about visual impairment? Yes Some knowledge Limited knowledge No

40. Does the school have experience supporting students with visual impairment? Yes Some experience No

41. Who is responsible for the student’s assistive technology?

42. Is guidance from a vision service or assistive technology service required? Yes No Already receiving support

43. Are classmates aware of the student’s visual impairment? Yes Partly No

44. Is there a need to provide information to the class about visual impairment? Yes No Already done

45. How does the student function during recess and breaks?

46. Does the student participate in play and group activities? Yes Sometimes Rarely No

Section 9: School Day and Practical Subjects

47. Does the student experience visual fatigue? Yes No Sometimes

48. Does the student need additional breaks? Yes No Sometimes

49. Does the student’s vision become more difficult as the day progresses? Yes No Sometimes

50. Strategies used for reading, writing and orientation

51. What is working well at present?

52. Which situations are the most challenging?

53. Physical Education Works well Some challenges Significant challenges

54. Arts and Crafts Works well Some challenges Significant challenges

55. Food and Health (Home Economics) Works well Some challenges Significant challenges

56. Field trips and outdoor education

Section 10: After-School Program

57. Does the student attend the after-school program? Yes No

58. Are the assistive devices also used during the after-school program? Yes No Partly

59. Have the after-school staff received the necessary training? Yes No Partly

Section 11: Parents’ Perspective

60. What works well at home?

61. What challenges do the parents experience at school?

62. What would the parents like to prioritize?

Section 12: Summary and Action Plan

63. Key findings from the assessment

64. Recommended interventions

65. Who is responsible for each follow-up action?

66. Date of the next evaluationmm/dd/yyyy

67. Additional comments

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