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PSYCHOSOCIAL EVALUATION Form

This document contains a psychosocial evaluation form for students returning to in-person classes. It includes 13 statements about various psychosocial factors like emotional safety, self-awareness, motivation, and perceived physical safety. Students are asked to indicate their level of agreement with each statement on a 5-point scale. The form also includes space for the student's name, grade, and section. The teacher provides an encouraging message at the bottom reminding the student to keep trying despite challenges.

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Shiella Mae Vispo
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49 views

PSYCHOSOCIAL EVALUATION Form

This document contains a psychosocial evaluation form for students returning to in-person classes. It includes 13 statements about various psychosocial factors like emotional safety, self-awareness, motivation, and perceived physical safety. Students are asked to indicate their level of agreement with each statement on a 5-point scale. The form also includes space for the student's name, grade, and section. The teacher provides an encouraging message at the bottom reminding the student to keep trying despite challenges.

Uploaded by

Shiella Mae Vispo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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PSYCHOSOCIAL EVALUATION

SY 2022 – 2023

NAME: GRADE & SECTION/STRAND:

PAGSUSURI SA SIKOSOSYAL PARA SA BALIK ESKWELA


Nais malaman ng iyong guro kung kumusta ang iyong mga iniisip o nararamdaman sa pagbabalik sa klase sa
pamamagitan ng mga pahayag sa ibaba. Tandaan na walang tama o maling sagot.

Para sa bawat pahayag, isipin kung gaano ka ka-sumasang-ayon dito. Kulayan ang mukha na tumutukoy sa lebel ng
iyong pagsang-ayon.
Lagyan ng (✓) ang numero ng iyong sagot sa bilang 1 – 8 at 9 -13.
FOR ITEMS 1 – 8 FOR ITEMS 9 – 13 (Psychosocial
(Psychosocial Well-being) 5 4 3 2 1 Well-being) 5 4 3 2 1

1. Emotional Safety 9. Affect


2. Self-awareness 10. Motivation
3. Self-expression 11. Perception of in-person
learning modality
4. Self-regulation 12. Perceived physical safety
5. Problem Solving 13. Self-agency towards physical
(help-seeking) safety
6. Problem Solving
(self-reliance)

7. Self-confidence
8. Empathy

“I am telling you it’s not going to be easy, But I see you trying… so keep going.”
(Teacher’s copy)

Memory Test Activity

This great activity is called the “Memory Test” activity.

Here’s how it works:

1. Tell participants that you are going to read them a list of words to test their memory.
2. Instruct them to listen carefully, as they cannot write down any of the words. Tell them you
will test them later to see how many of the words they can remember.
3. Repeat each of the following words slowly, pausing briefly between each word:
o dream
o sleep
o night
o mattress
o snooze
o sheet
o nod
o tired
o night
o artichoke
o insomnia
o blanket
o night
o alarm
o nap
o snore
o pillow
4. When you finish reading the list of words, distract your participants by talking about
something else for at least one full minute.
5. Once you have finished talking, have each participant write down as many words as they
can remember from the list.

You (and your participants) will find that it’s pretty difficult to remember a list of somewhat-random
words, especially when there is a break in time and another discussion in between hearing them
and recalling them!

Relate this to real-life listening by emphasizing the importance of paying attention to people when
they are speaking to you, especially if it’s an important conversation.
Power of Body Language

This activity will help your participants work on their body language skills.

Here’s how it works:

1. Tell the participants that you are going to give them a series of instructions and you want
them to follow them as fast as they can.
2. State the following actions as you engage in them:
a. Put your hand to your nose.
b. Clap your hands.
c. Stand up.
d. Touch your shoulder.
e. Sit down.
f. Stamp your foot.
g. Cross your arms.
h. Put your hand to your MOUTH (but while saying this one, put your hand to your
nose).
3. Observe how many participants copied what you did instead of what you said.

Share this observation with your group and lead a discussion on how body language can influence
our understanding and our reactions. It can reinforce what we hear or it can interfere with the
verbal communication we receive. The more aware we are of this possibility, the better
communicators we become. It’s vital to keep your own body language in mind, just as it’s vital to
notice and understand others’ body language.
We Have to Move Now!

Another great exercise from Grace Fleming (2018) is called “We Have to Move Now!” and it will
help your participants learn how to express and detect several different emotions.

These are the instructions for this activity:

1. Cut several strips of paper.


2. On each strip of paper, write down a mood, feeling, or disposition, like guilty, happy,
suspicious, paranoid, insulted, or insecure.
3. Fold the strips of paper so you can’t see what is written on it and place them in a bowl or
jar. These are your prompts.
4. Have each participant take a prompt from the bowl or jar and read the exact same sentence
to the class, but with the emotion the prompt specifies.
5. The sentence everybody will read is: “We all need to gather our possessions and move to
another building as soon as possible.”
6. Have the participants guess the emotion of each reader by writing down what they think the
speaker is feeling (or what they are supposed to be feeling).

After each participant has had a chance to read the sentence based on one of the prompts, run
through the emotions displayed and see how many each participant guessed correctly. Finally,
lead a debriefing discussion on how things like tone and body language can impact the way a
message is received.

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