WAT STEPS OFF LINE SFST GIVEN PROPER ORDER? YES NO WAT MISSES HEEL TO TOE? OLS PUTS FOOT DOWN MORE THAN 3? NYSTAGMUS CHECKED YES NO ALT TEST DONE AFTER SFST? ORDER? PROPER VIDEO ANGLE? OLS DECISION POINT 2 OR 3? "IS THERE ANY REASON...?" OLS USES ARMS TO BALANCE? "FACE MY ___." DIDN'T FOLLOW INST. WAT USES ARMS TO BALANCE USED SLOWLY TURN" OR PIVOT? CHECKED LACK OF SMOOTH PERSUIT WAT STOPS WHILE WALKING? WAT TOTAL POINTS BELOW 5? CAN'T BALANCE DURING INST WAT DECISION POINT: 2 OR 3? OLS HOPS OLS SWAYS YES NO? MEDICAL SCREEN GIVEN? WAT IMPROPER TURN OLS TOTAL POINTS? 2, 3, 0R 4 INDICATOR SHIRT PROBLEM? ________ WAT STEPS OFF LINE SFST GIVEN PROPER ORDER? YES NO WAT MISSES HEEL TO TOE? OLS PUTS FOOT DOWN MORE THAN 3? NYSTAGMUS CHECKED YES NO ALT TEST DONE AFTER SFST? ORDER? PROPER VIDEO ANGLE? OLS DECISION POINT 2 OR 3? "IS THERE ANY REASON...?" OLS USES ARMS TO BALANCE? "FACE MY ___." DIDN'T FOLLOW INST. WAT USES ARMS TO BALANCE USED SLOWLY TURN" OR PIVOT? CHECKED LACK OF SMOOTH PERSUIT WAT STOPS WHILE WALKING? WAT TOTAL POINTS BELOW 5? CAN'T BALANCE DURING INST WAT DECISION POINT: 2 OR 3? OLS HOPS OLS SWAYS YES NO? MEDICAL SCREEN GIVEN? WAT IMPROPER TURN OLS TOTAL POINTS? 2, 3, 0R 4 INDICATOR SHIRT PROBLEM? ________
(Print) Use this randomly generated list as your call list when playing the game. There is no need to say the BINGO column name. Place some kind of mark (like an X, a checkmark, a dot, tally mark, etc) on each cell as you announce it, to keep track. You can also cut out each item, place them in a bag and pull words from the bag.
WAT
STEPS OFF LINE
SFST GIVEN PROPER
ORDER?
YES NO
WAT
MISSES HEEL TO TOE?
OLS PUTS FOOT DOWN MORE THAN 3?
NYSTAGMUS CHECKED
YES NO
ALT TEST DONE AFTER SFST? ORDER?
PROPER VIDEO ANGLE?
OLS DECISION POINT 2 OR 3?
"IS THERE ANY REASON...?"
OLS
USES ARMS TO BALANCE?
"FACE MY ___." DIDN'T FOLLOW INST.
WAT
USES ARMS TO BALANCE
USED SLOWLY TURN" OR PIVOT?
CHECKED LACK OF SMOOTH PERSUIT
WAT
STOPS WHILE WALKING?
WAT
TOTAL POINTS BELOW 5?
CAN'T BALANCE DURING INST
WAT DECISION POINT: 2 OR 3?
OLS
HOPS
OLS SWAYS
YES NO?
MEDICAL
SCREEN GIVEN?
WAT
IMPROPER TURN
OLS TOTAL POINTS? 2, 3, 0R 4
INDICATOR
SHIRT PROBLEM?
________