Name ___________________________________________
Hellison’s Responsibility Checklist
5 = Always 4 = Almost always 3 = Sometimes 2 = Almost Never 1 = Never
1. Do you refrain from chewing gum & eating in class? ________
2. Do you wear Durant PE dress-out clothes & tennis shoes? ________
3. Do you take your jewelry off while in the locker room? ________
4. Do you take care of your restroom needs before entering the gym / activity area? ________
5. Do you arrive to the locker room on time? ________
6. Do you leave the locker room on time? ________
7. Do you behave appropriately & responsibly during warm-ups = no hitting, kicking, chasing, visiting)? ___
8. Do you do your best in activities that you personally do not enjoy? ________
9. Do you consider the needs of your classmates when making decisions (i.e., team selection, playing games
you may not enjoy, dealing with classmates less/more skilled than you, etc.)? ________
10. Do you complete all warm-up activities everyday? ________
11. Can the teacher count on you to stay on task even when she is not looking directly at you? ________
12. Do you encourage your classmates (no taunting, no making fun of, etc.)? ________
13. Do you sit quietly and face the teacher when instructions are given? ________
14. Do you use equipment properly and only when instructed to do so? ________
15. Do you work well with all of your classmates – not limiting your interactions to only a few people? ______
16. Do you follow the rules of the game, activity and/or drill in which you are participating? ________
17. Do you keep your PE clothes in your own assigned locker? ________
18. Do you lock your locker to keep you personal items safe? ________
19. Do you enter the gym before & after class the way you have been instructed to do so even if the teachers
are not looking? ________
20. Do you ask permission before leaving the gym or other assigned area? ________
________ Add the total number of points for numbers 1 thru 20 and write on the line.