DOCS

(DEVELOPMENTAL OBSERVATION CHECKLIST SYISTEM)

SECŢIUNEA 1. – DATE DE IDENTIFICARE

Numele copilului ___________________________________________ M_____ F_____

An Lună Zi

Data testării ___________ ________ ________

Data naşterii ___________ ________ ________

Vârsta testării ___________ ________ ________

Şcoala: _____________________________________________ Clasa ________________

Numele tutorelui: ___________________________________________________________

Relaţia cu copilul: __________________________________________________________

Numele examinatotului: ______________________________________________________

Gradul examinatorului: _______________________________________________________

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SECŢIUNEA II. – CONDIŢII DE ADMINISTRARE

DOCS a fost administrat în:

O şedinţă __________________________________ Timpul de administrare _____________

Două şedinţe ______________________________ Timpul de administrare ______________

Trei sau mai

multe şedinţe _____________________________ Timpul de administrare _______________

Locaţia _____________________________________________________________________

A fost oferită asistenţă pt. parcuregerea chestionarului: DA ____ NU ______

De cât timp îl cunoaşte tutorele pe copil: __________________________________________

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SECŢIUNEA III. – OBSERVAŢII, INTERPRETĂRI,

RECOMANDĂRI

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