Deaf-Blindness Evaluation Checklist
Bring together vision, hearing and communication data for students with combined sensory loss. A free, fillable checklist for school psychologists and evaluation teams.
What’s inside
- The federal eligibility requirements, each with space to note where the evidence is documented
- 11 commonly used measures to check off, with date tested, examiner and results
- Records, interviews, observations and screenings
- Planning considerations
- Evaluation timeline and a team summary box
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What IDEA requires for Deaf-Blindness
The checklist walks your team through each part of the federal definition so nothing is missed at the eligibility meeting:
- Concomitant hearing and visual impairments
- The combination causes such severe communication, developmental and educational needs that they cannot be met in programs solely for deafness or solely for blindness
- Adversely affects educational performance
- Student needs specially designed instruction
- State deaf-blind project contacted for support and the annual count
Summary of federal IDEA regulations (34 CFR §300.8(c)(2)). Your state may add criteria or use different terms. Follow state and district procedures.
Measures included in the checklist
No single test determines eligibility. The checklist lists measures school psychologists commonly use so you can document what was given, when and by whom:
- Vision: Eye report, Functional vision assessment, Learning media assessment
- Hearing: Audiological evaluation, Functional hearing / listening evaluation
- Communication: Communication evaluation (including tactile and alternative modes), AAC evaluation
- Development and function: Adaptive measure (Vineland-3 or ABAS-3), Orientation and mobility evaluation, Occupational / physical therapy evaluation, Observation across routines
Blank rows let you add any other measures your team uses.
Planning considerations
- Intervener or trained support staff
- Consistent communication system across settings
- Access to information and the environment
- Health and medical needs
- Family priorities
- Transition planning
Frequently asked questions
Is the checklist fillable?
Yes. You can type into it on a computer or print it. Check boxes are printed, and every date, examiner and notes field can be filled in digitally.
Does this replace my state or district forms?
No. It is a working checklist to organize data. Your state may add criteria or use different terms, so always follow state and district procedures and use their required forms.
Can I share it with my evaluation team?
Yes. Share it with colleagues on your team. If others want their own copy, send them to this page.