Checklist for Good Table Manners at Home

Checklist for Good Table Manners a= t Home

Parent/Guar= dian Skillstreaming Checklist

Parent’s /Guardian’s Name: ____________________________________

Child’s Name: ____________________________ Week Ending: _________________

We will be st= ressing good table manners during this semester.&n= bsp; Please summarize what you observed about your child’s table manners over the last week (Monday-Sunday) and return this form with your c= hild every Monday morning. At the = end of the semester, I will provide you with a chart that your child used to tracks his/her progress in achieving and continually displaying good table manners= at school and at home.

Circle number 1 if your ch= ild almost never did what the question asks.

Circle number 2 if your ch= ild seldom did it.

Circle number 3 if your ch= ild sometimes did it.

Circle number 4 if your ch= ild did it often.

Circle number 5 if your ch= ild almost always did it.

Washed hands before eating	1	2	3	4	5
Was polite (said “please” and “thank-you”) when you served the meal	1	2	3	4	5
Put napkin on lap	1	2	3	4	5
Used utensils	1	2	3	4	5
Kept elbows off table	1	2	3	4	5
Did not talk with food in mouth	1	2	3	4	5
Chewed with mouth closed	1	2	3	4	5
Asked to be excused from table	1	2	3	4	5
Cleaned up after eating	1	2	3	4	5
Cumulative = Score:	&nbs= p; / 45 points

Comments: __________________________________________________________________

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