0 - 3yr Checklist Signs to indicate OT may help 0 to 12 months If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Can't find hands by 2 months Not showing eye control to follow toys/people by 3 months No increased head control by 3 months Not swiping for toys by 4 months (laying on back/semi reclined) No hands to midline and mutual touching by 4 months No hands (then toy) to mouth by 4 months On tummy - not propping on elbow (then hands) by 3-4 months No increasing hand-eye coordination 5-6 months Not sitting independently 6-8 months Not rolling by 6-8 months Not passing toys from hand to hand by 7 months No isolation of index finger for poking/pointing by 8 months No purposeful release of cube by 10 months Can't pincer grasp by 12 months Can't open a book by 12 months (turning pages by 20 months) Can't clap by 10 - 12 months No object permanence by 12 - 18 months First Name * Last Name Phone * Email * Signs to indicate OT may help 1 to 3 years If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Any delays in previous list and/or concerns with any areas above Eye-hand coordination delays Poor use of hands together Heavy handed with toys/people Poor balance or coordination Scared of climbing at the park or craves swinging and being upside down Delays with regulation and self-regulation skills (still requiring a lot of adult support with this) impacting on engagement in daily occupations e.g. play or sleep Demands adult company constantly or has difficulties separating from parents Overly anxious/fearful in new situation or with new people Appears overly emotional, hypersensitive or anxious Unaware of others personal space Poor sleep patterns or requires extensive supports to fall asleep/stay asleep Not following simple routines/instructions Short attention span/fleeting attention e.g. Can only sit for brief periods and/or running off before activity is finished. Not persisting with activities when they are difficult, even with adult support Can’t change from one activity to another without distress Throwing regular tantrums or having frequent meltdowns Fussy eating Distressed with hair and/or face washing Needs helping with dressing tasks (undressing is mastered before dressing) Not drawing a vertical and horizontal line and a circle by three. Doesn't understand same and different by three Not engaging in pretend play by three First Name * Last Name Phone * Email *
