School Name Classroom/Room Number

Observer Name Observation Date

Room Type

General Classroom Music Room Gym Other

Number of Students Room Dimensions (Length x Width x Height in meters)

Is it easy to hear the teacher from the back of the room?

Yes No

Are there any noticeable echoes or reverberation?

None Somewhat Significant

Sources of Background Noise (Check all that apply)

HVAC (Heating/Air Conditioning) Hallway Noise Outdoor Noise Adjacent Classrooms Other

Are acoustic treatments present?

Yes No

Additional Comments/Observations