Sensory Self-Assessment

Instructions: For each sensory category below, circle the number that best describes how much that input helps you feel calm, focused, or regulated. (1 = Not at all, 3 = Sometimes, 5 = A lot)

Visual Input (e.g., bright colors, lights):

1 2 3 4 5

Auditory Input (e.g., music, ambient sounds):

1 2 3 4 5

Tactile Input (e.g., textures, squeezes, fidgets):

1 2 3 4 5

Movement Input (e.g., swinging, rocking, jumping):

1 2 3 4 5

Proprioceptive Input (e.g., pushing, pulling, heavy work):

1 2 3 4 5

Oral Input (e.g., chewing gum, crunchy snacks):

1 2 3 4 5

Reflection Questions

1. Which sensory input did you rate highest? Why do you think this input helps you?
   
   
   
   
   
   
   

2. Which sensory input did you rate lowest? How might you adjust or reduce that input when it feels overwhelming?
   
   
   
   
   
   
   

3. List two situations (at school or at home) where you could use your top-rated sensory strategy. Describe exactly how you would use it.
   
   
   
   
   
   
   
   
   
   
   
   

Build Your Toolbox

Materials Needed

• A container (e.g., small box, pencil case, zip pouch)
• Art supplies for decorating (markers, stickers, washi tape, ribbon)
• Your selected sensory tools (e.g., stress ball, fidget spinner, chewing tool, visual timer)
• Labels or small sticky notes

Step-by-Step Instructions

1. Gather Your Tools

   • Lay out all the sensory and self-regulation items you chose during the Strategy Exploration.
   • Check your top two or three sensory needs from the Sensory Self-Assessment.

2. Decorate Your Container

   • Use markers, stickers, or paper to personalize the outside.
   • Write your name or a calming word (e.g., “Breathe,” “Focus”) on the lid.

3. Organize Your Tools

   • Sort items by category (e.g., tactile tools together, oral tools together).
   • Place frequently used items where you can reach them quickly.

4. Label Each Section or Tool

   • Use small sticky notes or labels to name each tool and note when to use it (e.g., “Use during math,” “When I feel anxious”).

5. Add a Quick-Reference Card

   • On a small piece of paper, write the name of each tool, its purpose, and steps for use (e.g., “Balloon Breath: Breathe in slowly to fill ‘balloon,’ exhale to deflate”).
   • Tuck this card inside your toolbox for easy reminders.

6. Final Check

   • Make sure your tools match your sensory profile.
   • Close the container to confirm everything fits neatly and securely.

Tips for Personalization

• Choose colors, patterns, or images that make you feel calm or happy.
• Include a mix of silent tools (e.g., tactile items) and audible tools (e.g., soft squeeze ball).
• Test out one new tool at a time to see how it helps before adding more.
• Keep extra supplies at home or in your locker so you can refill as needed.

What’s Next?

When you’ve finished building your toolbox, use the Toolbox Reflection Rubric to evaluate how complete and useful your toolbox is.
Plan when and where you’ll keep it so it’s ready whenever you need it!

Toolbox Reflection Rubric

Use this rubric to evaluate the completeness, relevance, personalization, and reflection quality of your Regulation Toolbox. Circle the score for each criterion and discuss any areas for improvement with your teacher.

Scoring Guidance:

• Total your scores for a maximum of 16 points.
• A total of 12–16 points indicates strong readiness to use your toolbox.
• A total of 8–11 points suggests some areas to revisit with your teacher.
• A total below 8 points means you should adjust your toolbox and complete the reflection more fully.

After scoring, write one goal for improving your toolbox or your plan:

My Improvement Goal: