This chart is used in our school's 5th and 6th grade classes. It is broken down into the individual Math standards that are taught during our first trimester.
During the week's lessons, students have the opportunity to show their understanding through independent work. If they achieve a score of 80% or higher they have "Met Standards," therefore the student gets to color in one section of the specific standard.
After providing 3 pieces of evidence throughout the trimester, the student has then shown they he/she has MET or MASTERED that standard.
On our district report cards students receive a score of "Needs Improvement" "Progressing" or "Meets Most of the Standards." The key on the bottom is used throughout the trimester for students to always be aware of what their grade on their report card will be based on the amount of sections they've colored.
If you are interested in making this your "own" let me know. I can take your standard information and edit the form for you. =)