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Behavior Tracking Form for Students

This document is a behavior tracking form used by Fortuna Elementary School District to document incidents of inappropriate student behavior. It collects information about the student, date and time of incident, location, type of behavior infraction, possible motivations, others involved, and actions taken by staff in response. The form provides checkboxes and fill-in-the-blank fields to efficiently log details of behavioral issues and the school's response for tracking patterns over time.

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100 views1 page

Behavior Tracking Form for Students

This document is a behavior tracking form used by Fortuna Elementary School District to document incidents of inappropriate student behavior. It collects information about the student, date and time of incident, location, type of behavior infraction, possible motivations, others involved, and actions taken by staff in response. The form provides checkboxes and fill-in-the-blank fields to efficiently log details of behavioral issues and the school's response for tracking patterns over time.

Uploaded by

api-356011071
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

& Fortuna Elementary School District Minor Major

E Behavior Tracking Form


Student Info
Student (Full Name):________________________________________________________________________ Grade____________
Staff____________________________________________________________ Incident Date_____________ Time: _____:______
Location
Classroom Bus Bathroom Loading Zone Assembly Playground
Gym Off Campus Cafeteria Office Field Trip/Special Event
Library Computer Lab Common Areas After-School Program

Behavior
Disrespect Inappropriate Language Misuse of Property
Defiance Abusive Language Property Damage
Disruption Forgery/Theft/Plagiarism Harassment (mark specific type)
Insubordination Dress Code Disability Race Ethnicity

Non-compliance Skipping/Cutting Gender Sexual Religion

Lying/Cheating Physical Aggression Physical Other

Misuse of Technology Fighting Bullying


Physical Contact Inappropriate Location Other ____________________________
Inappropriate Display of Affection

Possible Motivation Obtain Peer attention Avoid Peer Attention Avoid Adult Attention
Avoid Tasks/ Activities Obtain Adult Attention Obtain Items/ Activities

Others involved:
No One Peers Teacher Staff Substitute Unknown Other:______________
Teacher Action for Major Log Completed in Aeries
Parent Contact Date:_________________________________ No Answer/Left Message
Action(s) Taken by Administration and/or Teachers:
Suspension ________ Days Time Out/Detention Reteach Program Counseling Referral
In School Out of School Peer Intervention Conference w/ Student Parent Contact
Bus Suspension Alternative Placement Time in Office Restitution
Loss of Privileges Individual Instruction Community Service Additional Attendance
Action Pending Other:_____________________

Previous Actions and Notes on Current Incident:

Student Signature___________________________ Parent Signature______________________________


PRINT CLEAR FORM

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