LEARNER SELF-REFLECTION

PURPOSE:
CORRELATION CHART
This is a self-assessment for individual learners that can FOR ASSESSMENT ITEMS
be administered before and after implementation of The
Zones of Regulation curriculum to determine progress
and guide instruction. Each item (or question) correlates Item # Correlating Lesson(s)
to core concepts and practices taught in the curriculum
as shown on the right. Use this tool to evaluate how well 1 Lessons 1-3
individual learners, as well as the whole class, have learned
key concepts and practices from The Zones of Regulation. 2 Lesson 6
When using as a whole class evaluation tool, compare
3 Lesson 4
the average score for the class before implementing the
curriculum to the average score after implementation to 4 Lesson 5
evaluate growth. You can also look for patterns within
individual items to guide whole group instruction. 5 Lesson 8

DIRECTIONS: 6 Lesson 9
Questions may be read independently, read aloud to
a group or asked 1-on-1 with learners. Learners may 7 Lessons 10-13
answer questions independently, or with the help of an
adult scribe. Have learners select one answer choice 8 Lessons 10-13
for each item. If necessary, share the definitions of key
vocabulary below. 9 Lessons 14 -16

VOCABULARY:
10 Lesson 17
Emotions - Words we use to label our feelings.
Manage - To take care of, or regulate, feelings.
Situation - What is happening in a time or place,
including people around you.

IF SCORING THIS ASSESSMENT:

Example:
10 I understand why it’s helpful to manage my feelings and energy throughout the day.

NOT YET SOMETIMES ALWAYS

Score each
item as follows: 1 Point 2 Points 3 Points Total

___ /30

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©2022 The Zones of Regulation
 STUDENT NAME: DATE:
Directions: Mark or circle your choice for each question.

1 I can list at least 7 emotions to name how I’m feeling besides happy, sad, and mad.

NOT YET SOMETIMES ALWAYS

2 I notice how my body feels inside when I’m happy, sad, mad, etc.

NOT YET SOMETIMES ALWAYS

3 I am comfortable sharing my feelings with others.

NOT YET SOMETIMES ALWAYS

4 I notice how people around me are feeling.

NOT YET SOMETIMES ALWAYS

5 I notice when my feelings change during the day.

NOT YET SOMETIMES ALWAYS

6 I can name things that often bother me or make me feel uncomfortable (such as loud
noises, changes in schedule, cutting in line).
NOT YET SOMETIMES ALWAYS

7 I know 2-3 tools or strategies I can use to calm down and feel in control.

NOT YET SOMETIMES ALWAYS

8 I know 2-3 tools or strategies I can use to feel more focused or energetic.

NOT YET SOMETIMES ALWAYS

9 I can use a tool or strategy to help me manage my strong feelings (such as feeling mad,
worried, out of control).
NOT YET SOMETIMES ALWAYS

10 I understand why it’s helpful to manage my feelings and energy throughout the day.

NOT YET SOMETIMES ALWAYS

©2022 The Zones of Regulation

REGULATION SKILLS INVENTORY
(Completed by Staff)

PURPOSE: CORRELATION CHART

Use this tool to evaluate skills and key concepts FOR ASSESSMENT ITEMS
taught in The Zones of Regulation™ curriculum. Each
item (or question) correlates to core concepts and Item # Correlating Lesson(s)
practices taught in the curriculum as shown on the
right. You may choose to administer this inventory pre 1 Lessons 1-3
and post intervention using The Zones of Regulation
2 Lesson 6
curriculum or midway through intervention as a way
to monitor progress. This inventory is not meant 3 Lesson 3,5
to be scored, rather results may be used to make
decisions regarding progress of individuals or groups 4 Lesson 6
of learners and to guide instruction. You can also look
for patterns within individual items to guide group 5 Lesson 8
instruction.
6 Lesson 4

DIRECTIONS: 7 Lessons 9
This assessment tool should be administered by a 8 Lessons 10 -13
facilitator who has an established positive relationship
with the learner. When completing this tool, reflect 9 Lessons 10 -13
on how the individual learner has exhibited each
competency over a period of 1-2 weeks. If possible, 10 Lesson 14 -15
use data such as learner anecdotal notes as a
reference when completing this tool and consider 11 Lessons 15
completing it with other adults who regularly work
with the learner. You may also prompt learners directly 12 Lesson 15
to reflect on specific question items, such as “How
does your body feel when you’re in the Blue Zone?”. 13 Lesson 16 -18

Learn more about The Zones of Regulation at zonesofregulation.com

©2022 The Zones of Regulation
LEARNER NAME: DATE ADMINISTERED:

ADMINISTERED BY:

1 2 3 4 5
Not Yet Rarely Some- Often Always
times

1 Learner has emotional vocabulary to identify their feelings.

Learner can identify the physical sensations associated with

2
different feelings such as heart racing when upset, etc.

3 Learner notices and identifies how others may be feeling.

4 Learner shares their feelings with supportive adults with ease.

Learner notices when their feelings and energy levels fluctuate

5
throughout the day.

Learner can predict how they might feel in a variety of situations

6
(such as a class celebration, or when someone calls them a name).

Learner can identify situations or conditions that are triggers for

7
them (such as loud noises, changes in schedule, cutting in line, etc).

Learner can identify and demonstrate a variety of tools/

8
strategies to help them calm down and feel in control.

Learner can identify and demonstrate a variety of tools/

9
strategies to help them feel more focused or energized.

With prompting or support, learner uses tools/strategies to

10
regulate their feelings or energy throughout the day.

Learner can independently use tools/strategies to regulate their

11
feelings or energy throughout the day.

When faced with a challenging situation and strong feelings,

12
learner can effectively choose and use tools/strategies to regulate.

Learner can describe how regulating their feelings/energy

13
impacts outcomes, such as social, academic, personal goals.

TOTAL

©2022 The Zones of Regulation

STAFF IMPLEMENTATION SURVEY
PURPOSE AND DIRECTIONS:
This Staff Survey is intended for use with facilitators that have been trained in The Zones of Regulation and
have familiarity with The Zones of Regulation curriculum and concepts. The first set of statements address staff
readiness, confidence, and beliefs around implementing The Zones of Regulation; the second set relate to
common classroom practices within The Zones that build a supportive climate for regulation. This survey can be
administered at the beginning and end of an implementation period, or midway through to monitor progress.
Note that results may be more accurate if survey responses are anonymous or tracked by instructional team
(such as grade level or department). Results can be used to guide targeted coaching and support, as well as
assess staff readiness, confidence, and practices in implementing The Zones of Regulation. You may compare
the average score for the staff at the beginning of an implementation period to the average score at the end of
the period to evaluate growth.

Learn more about The Zones of Regulation at zonesofregulation.com

©2022 The Zones of Regulation
NAME: (optional) DATE:

GRADE LEVEL/DEPARTMENT:

1 2 3 4 5
Strongly Neither Strongly
Disagree Disagree Agree or
Disagree
Agree Agree

I believe in the value of implementing The Zones to support

1
learners’ regulation development and wellbeing.

I feel confident in my knowledge and ability to teach The

2
Zones of Regulation in my space.

I feel supported in implementing The Zones of

3
Regulation by my leadership team.

I have adequate time to teach and practice The Zones of

4
Regulation with my learners.

My classroom climate and practices promote a safe space

5
to regulate and gain independence in doing so.

1 2 3 4 5
Not Yet Rarely Some- Often Always
times

I consistently model regulation through stating my own

6
feelings (Zone) and using my regulation tools in my space.

I integrate Zones visuals and language throughout the day,

7
such as in character discussions or “teachable moments”.

I provide learners the opportunity to check-in with and

8
communicate their feelings in my space (Zones Check-in).
Learners are equipped with (or can access) regulation
9 tools and strategies in my space and I have routines and
expectations for using them.
When my learners are struggling with regulation, I support
10 them in finding healthy ways to manage their feelings and
using tools to regulate within my space.

Score: ___ /50

©2022 The Zones of Regulation