ACTIVITY:

PHYSICAL ASPECTS

1. What is the primary body position required?

prone kneeling sitting standing other

2. What parts of the body are required?

arms _____ neck _____ hands _____
head _____ legs _____ feet _____
upper torso _______ lower torso ______

3. What types of movement does the activity require?

bending______ stretching_____ running______
standing_____ walking_______ reaching_____
grasping_____ punching______ catching______
throwing_____ hitting________ skipping______
hopping______

4. Coordination between parts and movements:

Much 1 2 3 4 5 Little

5. What are the primary senses required for the activity?

Rate: 0= not at all; 1= rarely; 2= occasion; 3= often

6. Hand-eye Coordination:
Much 1 2 3 4 5 Little

7. Strength:
Much 1 2 3 4 5 Little

8. Speed:
Much 1 2 3 4 5 Little

9. Endurance
Much 1 2 3 4 5 Little

10. Energy:
 Much 1 2 3 4 5 Little

11. Flexibility:
Much 1 2 3 4 5 Little

12. Degree of cardiovascular activity involved:

Much 1 2 3 4 5 Little

SOCIAL ASPECTS

1. Interaction Pattern (check only one pattern)

__intra-individual: Action taking place within the mind or action
involving the mind and a part of the body
- requires no contact with another person
or external object
__extra-individual: Action directed by a person toward an
object
-requires no contact with another person
__aggregate: Action directed by a person toward an
object while in the company of other
persons who are also directing actions
towards objects
- action is not directed toward each other
- no interaction between participants is
required or necessary
__inter-individual: Action of a competitive nature directed by
one person toward another
__unilateral: Action of a competitive nature among three
or more persons, one of whom is an
antagonist or “it”
-interaction is in simultaneous competitive
relationship
__multilateral: Action of a competitive nature among three
or more persons with no one person as an
antagonist
 __intra-group: Action of a cooperative nature by two or
more persons intent upon reaching a mutual
goal
-action requires positive verbal or nonverbal
interaction

2. How many participants does the activity require?

_________________

3. How closely spaced are the participants?

Closely 1 2 3 4 5 Distant

4. Can everyone communicate with everyone else by nature of

the activity?
Yes_____ No_____

5. Does the activity require cooperation or competition? (circle

one)

6. How much physical contact does the activity demand?

Much 1 2 3 4 5 Little

7. Does the activity promote sexual homogeneity or

heterogeneity?
Explain: ___________________________________________________

8. How structured is the activity?

Highly 1 2 3 4 5 Freely

9. Noise Level
High 1 2 3 4 5 Low

COGNITIVE ASPECTS

1. How many rules are there?

Many 1 2 3 4 5 Few
2. How complex are the rules that must be adhered to?
Complex 1 2 3 4 5 Simple

3. How much long-term memory is necessary?

Much 1 2 3 4 5 Little

4. How much immediate recall memory is necessary?

Much 1 2 3 4 5 Little

5. How much strategy does the activity require?

Much 1 2 3 4 5 Little

6. How much verbalization of thought process is required?

Much 1 2 3 4 5 Little

7. How much concentration is required?

Much 1 2 3 4 5 Little

8. How often are the following skills used?

0= never; 1= rarely; 2= occasionally; 3= often
Reading_____ Math_____
Writing _____ Spelling_____

9. Intellectual skill required

Much 1 2 3 4 5 Little

10. Complexity of scoring

Very Complex 1 2 3 4 5 Not Complex

11. Rate the demands for the following identifications:

Often Never
Form and Shape 1 2 3 4 5
Colors 1 2 3 4 5
Size 1 2 3 4 5
Tactile 1 2 3 4 5
Objects 1 2 3 4 5
Classes 1 2 3 4 5
Numbers 1 2 3 4 5
Nonverbal Questions 1 2 3 4 5
Auditory Symbols 1 2 3 4 5
Visual Symbols 1 2 3 4 5
Concrete Thinking 1 2 3 4 5
Abstract Thinking 1 2 3 4 5
Body Parts 1 2 3 4 5

12. Check directionality required:

Left/Right_____ Up/Down_____
Around_____ Over/Under_____
Person/Object_____ Person/Person_____
Object/Object_____

AFFECTIVE ASPECTS

1. Rate the opportunities for the expression of the following

emotions during this activity
Often Never
Joy 1 2 3 4 5
Guilt 1 2 3 4 5
Pain 1 2 3 4 5
Anger 1 2 3 4 5
Fear 1 2 3 4 5
Frustration 1 2 3 4 5
ADMINISTRATION ASPECTS

1. Leadership: specific activity-skill expertise _____

general activity-skill ability_____
supervisory _____
none needed _____

2. Equipment: none required _____

specific commercial product _____
can be made _____

3. Facilities: none required _____

specific natural environment _____
specific man-made _____
environment

4. Duration: set time _____

natural end _____
continuous _____

5. Participants: any number _____

fixed number or multiple _____