Sample Assessment Forms

A number of sample forms are included for teachers to use in gathering assessment data. Some can be used in Level A of the decision-making process to assess a student’s ability to gather information and then to evaluate both the information and the sources of information. Other forms can be used in Level B of the decision-making process to gather data regarding a student’s ability to make an informed decision. Samples are also included for use in Level C of the decision-making process, to assist in assessing a student’s ability to design an action plan and to carry out an action plan.

The sample forms are offered as suggestions. Teachers can copy a sample from the curriculum guide and use it as designed or adapt it to meet particular needs. An electronic version of these forms can be downloaded and adapted as required from the Evergreen Curriculum section of Saskatchewan Learning’s web site at the following URL address: http://www.sasked.gov.sk.ca/docs/ evergrn.html. When you reach this web page, choose “Select by Subject”. Then click on either the Health Education icon or the Physical Education icon which will take you to the on-line curriculum documents. You can find and download the form you require and adapt it to meet your needs.

Printing and copying these templates Requires Acrobat Reader

• Student Evaluation in Unit Two: Strands of Wellness - First Example
• Student Evaluation in Unit Two: Strands of Wellness - Second Example
• Sample Rating Scale to Assess Student-created Posters
• Sample Rating Scale Form
• Assessing a Project or Written Assignment
• Sample Checklist to Assess a Written Assignment
• Assessing Group Presentations
• Student Self-assessment for Preparing and Conducting an Interview
• Feedback to Student Volunteer
• Sample Anecdotal Record Form for a Discussion or Talking Circle
• Self-assessment: My Group Skills/Performance
• Sample Co-operative Group Skills Assessment Form
• Sample Discussion Checklist
• Sample Rating Scale for Co-operative Group Learning
• Sample Matrix to Support Making a Decision in Wellness 10
• Sample Checklist to Assess Student Decision-making in Level B: Make an Informed Decision
• Student Self-assessment and Support Person Assessment in Level B: Make an Informed Decision
• Designing a Single-strand Action Plan for Wellness
• Designing a Two-strand Action Plan for Wellness
• Interviewing to Assess the Design Phase of Student Action Plans for Wellness
• Sample Rubric to Assess the Design Phase of a Single-strand Action Plan for Wellness
• Sample Rubric to Assess the Design Phase of a Two-strand Action Plan for Wellness
• Sample Support Person’s Feedback about a Single-strand Action Plan for Wellness
• Sample Support Person’s Feedback about a Two-strand Action Plan for Wellness
• Sample Rubric for Assessing the Implementation of a Single-strand Action Plan for Wellness
• Sample Rubric for Assessing the Implementation of a Two-strand Action Plan for Wellness