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Observation Report
Your Name
(Required)
First
Last
Today’s Date is: 20/01/2026
Date
(Required)
DD slash MM slash YYYY
Email
(Required)
Name of participant:
(Required)
Location:
(Required)
Name of person observing & completing form:
(Required)
Time Start
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Time End
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Length of time in minutes:
(Required)
Location / Environment:
(Required)
Give a short description of the location where observation is being made.
Observations / Cues of Distress:
(Required)
Self-talking
Speaking in a raised voice or tone
Speaking in a raised voice or tone
Swearing
Repeating demands
Declining or refusing activity
Walking away abruptly
Pacing
Rocking
Verbalisations / in audible noises
Grinding teeth
Clenching fist or other body parts
Staring into space
Glaring
Other
If other, please describe
(Required)
Activity:
(Required)
Visitors
With a family member
Home activity
Community activity
Work
Interacting with co-tenant
Interacting with Support Worker / staff
Other
If other, please describe
(Required)
Triggers:
(Required)
Change in routine
Waiting for an activity to start
Waiting for an activity to start
Not able to access a desired activity
Not able to access a desired item
Activity ended
Sensory trigger
Staff / parent /carer attention diverted elsewhere
Supported by an unfamiliar support worker
Transitional / staff changeover
Skills deficit
Other
If other, please describe:
(Required)
Description
Briefly describe the situation (in own words)
What strategies did you try or implement?
(Required)
What worked?
(Required)
Reflecting, what might you try differently next time?
(Required)
