OT Pre-Referral Checklist


Have an overload of OT recommendations? Sort through the pile with an OT screening form. The OT Pre-Referral Checklist is the perfect screening questionnaire for parents/teachers/the IEP team. Use this editable pre-screening form as an addition to your screening, to determine whether a student should be referred for a comprehensive OT evaluation or not.

This is a digital file that opens to an editable document on your Google Drive account.


The Occupational Therapy Daily Notes Template is a digital product. You will receive an email after purchase delivering a PDF which opens an editable document on your Google Drive. Work in the document to create daily progress notes. Edit the file as you see fit to meet your documentation needs.

The OT Pre-Referral Checklist is a pre-screening tool to help you sort through your pile of referrals.

This editable document opens in your Google Drive account. Create a master copy and then make a copy for each new referral to streamline the screening and evaluation process.

The OT Pre-Referral Checklist includes:

  • Background information to support writing IEP report
  • Scheduling information to streamline observation times/dates
  • Sections that can be printed out and handed to the IEP team for information on specific needs, current accommodations/modifications, and expected outcomes
  • OT screening checklist with space for notes on specific areas that may be addressed by school-based OT professionals: fine motor strength and coordination, pre-writing/writing skills, visual processing (eye movements, visual motor and perception), sensory motor skills, work behaviors, self-help skills, gross motor skills
  • Each section includes space for specific notes on how the student’s educational performance is impacted due to challenges in the skill areas.

The OT Pre-Referral Checklist is a a Total Report product, written by Krupa Panchmatiya Kuruvilla MA, OTR/L