Classroom Observation Form Observer:Instructor:Date:Grade:Subject:Size of Class/ Arrangement:Directions: In the Observation section, record your observations of the instructors' instruction and classroom environment. Record what you see and hear and link your observations to a component of teaching. Avoid statements of opinion. When the classroom instruction is complete, take a few moments to complete the Feedback section of the form. In this area, write two compliments about the instruction and two suggestions for improvement of his or her instruction. You may also find it useful to write an overall reflection of the classroom instruction. Please talk to the instructor being observed for specific guidance about particular elements of teaching for which he or she would like to receive feedback. Observation Creating an Environment of Respect and Rapport Communicating Clearly and Accurately Instructor interaction with learners; learner interaction. Directions and procedures; oral and written language. Establishing a Culture for Learning Using Questioning and Discussion Techniques Importance of the content; learner pride in work; expectations for learning and achievement. Quality of questions; discussion techniques; learner participation. Managing Classroom Procedures Engaging Learners in Learning Management of instructional groups, transitions, materials, and supplies; performance of non-instructional duties; supervision of volunteers and paraprofessionals. Representation of content; activities and assignments; grouping of learners; instructional materials and resources; structure and pacing. Managing Learner Behavior Providing Feedback to Learners Expectations; monitoring of learner behavior; response to learner misbehavior. Quality, accurate, substantive, constructive, and specific; timeliness. Organizing Physical Space Demonstrating Flexibility and Responsiveness Safety and arrangement of furniture; accessibility to learning and use of physical resources. Lesson adjustment; response to learners; persistence. Based on the framework for teaching, developed by C. Danielson. Danielson, C. (1996). Enhancing professional practice: A framework for teaching. Alexandria, VA: ASCD. Observer:Instructor:Date:Grade:Subject:Size of Class or Arrangement: "2 + 2" Feedback Compliments 1. 2. Suggestions 1. 2. Reflections 1 Capella Proprietary and Confidential classroom_observation.rtf Last updated: 2/14/2022 12:11 PM Case Example A Car Wreck Dylan, a 15-year-old high school student, was referred to a psychiatrist to deal with the stress from being involved in a serious automobile accident, Dylan was riding in the front passenger seat when, as the car was pulling out of a driveway, it was struck by an oncoming SUV that was speeding through a yellow light. The car he was in was hit squarely on the driver’s side, which caused the car to roll over once and come to rest right side ...

1. Classroom Observation Form
Observer:Instructor:Date:Grade:Subject:Size of Class/
Arrangement:Directions: In the Observation section, record
your observations of the instructors' instruction and classroom
environment. Record what you see and hear and link your
observations to a component of teaching. Avoid statements of
opinion. When the classroom instruction is complete, take a few
moments to complete the Feedback section of the form. In this
area, write two compliments about the instruction and two
suggestions for improvement of his or her instruction. You may
also find it useful to write an overall reflection of the classroom
instruction. Please talk to the instructor being observed for
specific guidance about particular elements of teaching for
which he or she would like to receive feedback.
Observation
Creating an Environment of Respect and Rapport
Communicating Clearly and Accurately
Instructor interaction with learners; learner interaction.
Directions and procedures; oral and written language.
Establishing a Culture for Learning
Using Questioning and Discussion Techniques
Importance of the content; learner pride in work; expectations
for learning and achievement.

2. Quality of questions; discussion techniques; learner
participation.
Managing Classroom Procedures
Engaging Learners in Learning
Management of instructional groups, transitions, materials, and
supplies; performance of non-instructional duties; supervision
of volunteers and paraprofessionals.
Representation of content; activities and assignments; grouping
of learners; instructional materials and resources; structure and
pacing.
Managing Learner Behavior
Providing Feedback to Learners
Expectations; monitoring of learner behavior; response to
learner misbehavior.
Quality, accurate, substantive, constructive, and specific;
timeliness.
Organizing Physical Space
Demonstrating Flexibility and Responsiveness
Safety and arrangement of furniture; accessibility to learning
and use of physical resources.

3. Lesson adjustment; response to learners; persistence.
Based on the framework for teaching, developed by C.
Danielson.
Danielson, C. (1996). Enhancing professional practice: A
framework for teaching. Alexandria, VA: ASCD.
Observer:Instructor:Date:Grade:Subject:Size of Class or
Arrangement:
"2 + 2" Feedback
Compliments
1.
2.
Suggestions
1.

4. 2.
Reflections
1
Capella Proprietary and Confidential
classroom_observation.rtf
Last updated: 2/14/2022 12:11 PM
Case Example A Car Wreck

5. Dylan, a 15-year-old high school student, was referred to a
psychiatrist to deal with the stress from being involved in a
serious automobile accident, Dylan was riding in the front
passenger seat when, as the car was pulling out of a driveway, it
was struck by an oncoming SUV that was speeding through a
yellow light. The car he was in was hit squarely on the driver’s
side, which caused the car to roll over once and come to rest
right side up. The collision of metal on metal made an
extremely loud noise. The driver of the car, a high school
classmate, was knocked unconscious for a short period and was
bleeding from a gash in his forehead. Upon seeing his injured
friend, Dylan became afraid that his friend might be dead. His
friend in the back seat of the car was frantically trying to
unlatch her seat belt. Dylan’s door was jammed, and Dylan
feared that their car might catch fire while he was stuck in it.
After a few minutes, the driver, Dylan, and the other passenger
were able to exit through the passenger doors and move away
from the car. They realized that the driver of the SUV was
unharmed and had already called the police. An ambulance was
on its way. All three were transported to a local emergency
room, where they were attended to and released to their parents’
care after a few hours.
Dylan had not had a good night’s sleep since the accident.
He often awoke in the middle of the night with his heart racing,
visualizing oncoming headlights. He was having trouble
concentrating and was unable to effectively complete his
homework. His parents, who had begun to drive him to and from
school, noticed that he was anxious every time they pulled out
of a driveway or crossed an intersection. Although he had
recently received his driving permit, he refused to practice
driving with his father. He was also unusually short-tempered
with his parents, his younger sisters, and his friends. He had
recently gone to see a movie but had walked out of the theater
before the movie started; he complained that the sound system
was too loud. His concerned parents tried to talk to him about

6. his stress, but he would irritably cut them off. After doing
poorly on an important exam, however, he accepted the
encouragement of a favorite teacher to go to a psychiatrist.
When seen, Dylan described additional difficulties. He
hated that he was “jumpy” around loud noises, and he could not
shake the image of his injured and unresponsive friend. He had
waves of anger toward the driver of the SUV. He reported
feeling embarrassed and disappointed in himself for being
reluctant to practice driving. He stated that about 5 years
earlier, he had witnessed the near-drowning of one of his
younger sisters. Also, he mentioned that this past month was the
first anniversary of his grandfather’s death.
Case Example
“Knee Pain” **
“Peter Winters, a 46 year old white minister, was referred to the
psychiatry outpatient department by his primary care doctor for
depressive symptoms and opioid misuse in the setting of chronic
right knee pain.
Mr. Winters injured his right knee playing basketball 17 months
earlier. His mother gave him several tablets of hydrocodone-
acetaminophen that she had for back pain, and he found this
helpful. When he ran out of the pills and his pain persisted, he
went to the emergency room. He was told he had a mild sprain.
He was given a 1 month supply of hydrocodone-acetaminophen.
He took the pills as prescribed for 1 month, and his pain
resolved.
After stopping the pills, however, Mr. Winters began to
experience a recurrence of the pain in his knee. He saw an
orthopedist, who ordered imaging studies and determined there
was no structural damage. He was given 1 month supply of

7. hydrocodone-acetaminophen. This time, however, he needed to
take more than prescribed in order to ease the pain. HE also
felt dysphoric and “achy” when he abstained from taking the
medication, and described a “craving” for more opioids. He
returned to the orthopedist, who referred him to a pain
specialist.
Mr. Winters was too embarrassed to go to the pain specialist,
believing that his faith and strength should help him overcome
the pain. He found it impossible to live without the pain
medication, however, because of the dysphoria, and muscle
aches when he stopped the medication. He also began to “enjoy
the high” and experienced intense craving. He began to
frequent emergency rooms to receive more opioids, often lying
about the timing and nature of his right knee pain, and even
stole pills from his mother on two occasions.. He became
preoccupied with trying to find more opioids, and his work and
home life suffered. He endorsed low mood, especially when
contemplating the impact of opioids on his life, but denied any
other mood or neurovegetative symptoms. Eventually, he told
his primary care doctor about his opioid use and low mood, and
that doctor referred him to the outpatient psychiatry clinic.
Mr. Winters had a history of two lifetime major depressive
episodes that were treated successfully with escitalopram by his
primary care doctor. He also had a history of an alcohol use
disorder when he was in his 20’s. He managed to quit using
alcohol his own after a family intervention. He smoked to
packs of cigarettes daily. His father suffered from depression,
and “almost everyone” on his mother’s side of the family had
“issues with addiction.” He had been married to his wife for
20 years, and they had two school-age children. He had been a
minister in his church for 15 years. Results of a recent physical
examination and laboratory testing performed by his primary
care physician had been within normal limits.

8. On mental status examination, Mr. Winters was cooperative and
did not exhibit any psychomotor abnormalities. He answered
most questions briefly, often simply saying “yes” or “no.”
Speech was of a normal rate and tone, without tangentiality or
circumstantiality. He reported the his mood was “lousy,” and
his affect was dysphoric and constricted. He denied symptoms
of paranoia or hallucinations. He denied any thoughts of
harming himself or others. Memory, both recent and remote,
was grossly intact.
**Barnhill, J.W., (Ed.). 2014.
I have been submitting case studies that we had to come with
the diagnosis however, with this assignment we have to make
the case. Please see attachment for one of the case studies you
used to complete a previously assignment for me. Please do not
copy the case study I am attaching it for referencing only.
See assignment below:
This is a "reverse" case assignment. Imagine that you have just
been assigned a new client in Internship. From what you have
been told, the diagnosis for the client, made by his/her
psychiatrist, is Post Traumatic Stress Disorder, Persistent
Depressive Disorder (Dysthymia), and Alcohol Use Disorder.
You are to write up a "history" for this client, that will leave
the reader with no choice but to agree with these diagnoses. As
you report in your case study presenting "issues" or concerns
that confirm/align with the diagnostic criteria for one of the
diagnoses above, point that out in your narrative. For example,
if "Ms. Allen reports having nightmares about the accident 3 or
4 times per week." This meets the criteria for PTSD "recurrent
distressing dreams of the event." (citation)
You must provide background information such as demographic
data, physical/biological/psychological/social history (ie:

9. health, prior health, prior mental health history including prior
treatment, medications, history of suicide attempts, suicidal
thoughts/intent/attempts, family and work history, and so on.
As in the other case examples you have been working on these
past weeks, you must "make the case" for the client's having
been diagnosed the way he/she has been. In other words, you
must include in your narrative how these disorders came about
and what was going on in the client's life, that ultimately ended
up manifesting in these diagnoses. If you like, you can
formulate a basic treatment plan, though it is not required.
This paper should be in APA format, with a cover page and
reference page. PLEASE REFER TO THE APA FORMAT
RESOURCES. Use your textbook and your DSM 5. If you wish
to use any other sources, that's fine but remember that ".com"
websites are not academic sources. Three double-spaced pages
of narrative is the minimum and the upper limit is 4 pages at
most. Write clearly, concisely and be specific!
Assignment will be submitted for plagiarism
Summary of Peer Feedback
Directions: Complete this record for each peer observation of
your teaching. One of these observations may be the one of your
lesson that was planned in Unit 4. The completed form
including the Reflection is due in Unit 6 in partial fulfillment of
the course project for ED5501.
Name
Date

10. Position (Provide grade level and subject, if instructor)
Peer Observations
Peer Observer
Date of Observation
Focus of the observation
related to PGP
Did observer collect evidence using Framework?
Did observer offer feedback using 2+2?
1.
2.
3. (optional)
Observation/Feedback 1
Focus of the observation:

11. If Observer used Framework to gather information:
· Name of component (or components) addressed:
· Specific evidence cited by observer in component:
· Specific feedback from observer based on this evidence:
· How you will use this information to improve your practice?
Be specific.
· How does this relate to your Professional Growth Plan
improvement goal?
If Observer used 2+2 Performance Appraisal:
Share a compliment and suggestion:
How you will use this information to improve your practice?
How does this relate to your Professional Growth Plan
improvement goal?
Observation/Feedback 2
Focus of the observation:
If Observer used Framework to gather information:
· Name of component (or components) addressed:
· Specific evidence cited by observer in component:

12. · Specific feedback from observer based on this evidence:
· How you will use this information to improve your practice?
Be specific.
· How does this relate to your Professional Growth Plan
improvement goal?
If Observer used 2+2 Performance Appraisal:
Share a compliment and suggestion:
How you will use this information to improve your practice?
How does this relate to your Professional Growth Plan
improvement goal?
Observation/Feedback 3
Focus of the observation:
If Observer used Framework to gather information:
· Name of component (or components) addressed:
· Specific evidence cited by observer in component:
· Specific feedback from observer based on this evidence:
· How you will use this information to improve your practice?
Be specific.

13. · How does this relate to your Professional Growth Plan
improvement goal?
If Observer used 2+2 Performance Appraisal:
Share a compliment and suggestion:
How you will use this information to improve your practice?
How does this relate to your Professional Growth Plan
improvement goal?
Summary
Summarize what you learned from having your peers observe
and provide structured feedback on your teaching. In particular,
what assisted you with your instructional improvement goal (or
goals)?
As you reflect on your experiences in having your colleagues
observe you, what was most valuable? What would you do
differently, if you were to have another colleague observe you?

14. 1
Capella Proprietary and Confidential
summary_of_peer_feedback.rtf
Last updated: 2/14/2022 12:10 PM
Peer Feedback on Your Teaching Scoring Guide
Due Date: End of Unit 6
Percentage of Course Grade: 10%.
CRITERIA
NON-PERFORMANCE
BASIC
PROFICIENT
DISTINGUISHED
Evaluate feedback received from professional colleagues.
33%
Does not evaluate feedback received from professional
colleagues.
Lists but does not evaluate feedback received from professional
colleagues.
Evaluates feedback received from professional colleagues.
Evaluates feedback received from professional colleagues

15. aligned with current research related to best practices in
instructional improvement.
Integrate feedback received from professional colleagues into
the development of actions steps for improving instructional
skills.
33%
Does not integrate feedback received from professional
colleagues into the development of actions steps for improving
instructional skills.
Describes feedback received from professional colleagues but
does not integrate feedback into any actions steps for improving
instructional skills.
Integrates feedback received from professional colleagues into
the development of actions steps for improving instructional
skills.
Integrates feedback received from professional colleagues and
aligns actions steps for improving instructional skills with
current research related to best practices in instructional
improvement.
Reflect on the advantages and disadvantages of peer observation
as a tool to collaborate with other professionals to improve
instruction.
34%
Does not reflect on the advantages and disadvantages of peer
observation as a tool to collaborate with other professionals to
improve instruction.
Reflects on either the advantages or disadvantages of peer
observation as a tool to collaborate with other professionals to
improve instruction, but does not address both perspectives.
Reflects on the advantages and disadvantages of peer
observation as a tool to collaborate with other professionals to
improve instruction.
Reflects on the advantages and disadvantages of peer
observation as a tool to collaborate with other professionals to
improve instruction supported with personal examples.

16. Peer Feedback on Your Teaching
Overview
The purpose of this assignment is for the learners to see how
their peers view their teaching proficiency. Colleagues can be a
valuable source of information in terms of a learner's ability to
receive feedback on what is actually happening in his or her
classroom. The student will be observed on at least two
occasions. One of these will be a videotaped lesson. The
learner's partner in this assignment will complete the
observation form. Learners should use the Classroom
Observation Form as well as the Summary of Peer Feedback
Form. Once the assignment has been completed, the learner
should submit the Peer Feedback Form to the course. This
assignment will allow the learner to receive feedback on his or
her work in a personal manner from someone who understands
the environment in which the learner is teaching.
By successfully completing this assessment, you will
demonstrate your proficiency in the following course
competency and assessment criteria:
· Competency 1: Evaluate instruction for professional
development.
. Evaluate feedback received from professional colleagues.
· Competency 2: Improve instruction and professional learning.
. Integrate feedback received from professional colleagues into
the development of actions steps for improving instructional
skills.
· Competency 3: Demonstrate the dispositions expected of a
professional educator and self-directed learner.
. Reflect on the advantages and disadvantages of the peer
observation as a tool to collaborate with other professionals to
improve instruction.
Assignment Description
Use the Summary of Peer Feedback Form before the first peer
visit so you know what will be expected as documentation of
the observations by your peers.

17. In preparation for the visit, explain the feedback process and its
context to your peer observer. Share your improvement goal and
what you would like your observer to pay particular attention to
throughout the lesson. Be sure your colleague understands that
you will be asking for written feedback using the Classroom
Observation Form. You do not need to submit a copy of the
forms, but you will need to refer to them when you prepare your
summary.
Step One
To complete this assignment, follow the instructions on the
following forms:
· Classroom Observation Form.
· Summary of Peer Feedback Form.
Step Two
· Submit the Peer Feedback Form to your instructor.
Refer to the Peer Feedback on Your Teaching Scoring Guide to
ensure that you meet the grading criteria for this assignment.