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Run: Pediatric Developmental Motor Assessment Inspection

Use this Pediatric Developmental Motor Assessment Inspection template to verify standardized administration, scoring, and interpretation of a child’s motor a...

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Assessment Details

Assessment date and time documented

Child age at time of assessment documented

Standardized motor assessment identified

Note (optional)

Assessment purpose documented

Document whether the assessment was completed for screening, baseline evaluation, progress monitoring, or discharge planning.

Note (optional)

Testing Conditions and Child Readiness

Child was alert, medically stable, and able to participate critical (required)

Yes No N/A

Testing environment was quiet, safe, and free from distractions

Yes No N/A

Required accommodations or modifications documented

Document any approved accommodations such as rest breaks, adaptive positioning, interpreter support, or sensory supports, and note whether they were consistent with standardized administration rules.

Yes No N/A

Note (optional)

Behavior, attention, and cooperation level documented

Note (optional)

Administration Fidelity

Test instructions were delivered consistently with the manual critical (required)

Yes No N/A

Items were administered in the correct sequence and age-appropriate start point critical (required)

Yes No N/A

Basal and ceiling rules were applied and documented critical (required)

Yes No N/A

Any deviations from standardized administration were documented

Scoring and Developmental Interpretation

Raw scores documented for each administered subtest critical (required)

Yes No N/A

Note (optional)

Standard scores or percentile ranks documented critical (required)

Yes No N/A

Note (optional)

Developmental age equivalents documented where applicable critical (required)

Yes No N/A

Note (optional)

Results interpreted for gross motor, fine motor, or overall motor delay

Note (optional)

Clinical Summary and Follow-Up

Summary includes functional impact of motor findings

Yes No N/A

Note (optional)

Recommendations for therapy, referral, or re-evaluation documented critical (required)

Yes No N/A

Note (optional)

Results communicated to caregiver or referring provider as appropriate

Yes No N/A

Note (optional)

Inspector sign-off completed critical (required)

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