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Behavior Incident Report Template

The Behavior Incident Report outlines the details of an incident involving a student, including the date, time, location, and individuals involved. It specifies immediate actions taken, types of behavior exhibited, and any disciplinary actions or follow-up plans. The report also includes sections for detailed descriptions of the incident and signatures from the reporting teacher and reviewing administrator.

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emanwemix
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62 views1 page

Behavior Incident Report Template

The Behavior Incident Report outlines the details of an incident involving a student, including the date, time, location, and individuals involved. It specifies immediate actions taken, types of behavior exhibited, and any disciplinary actions or follow-up plans. The report also includes sections for detailed descriptions of the incident and signatures from the reporting teacher and reviewing administrator.

Uploaded by

emanwemix
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

Behavior Incident Report

Incident Details Actions Taken


Date of Incident MM/DD/YYYY Immediate Actions/Interventions

Time of Incident HH:MM AM/PM Describe the steps taken right after the incident, such as separating
students, contacting parents or applying classroom consequences.
Location of Incident Classroom, playground or hallway

Individuals Involved
Reported By Name of the teacher or staff member

Student Exhibiting Behavior Name of student involved

Witnesses (if applicable) Disciplinary Action or Consequences (check all that apply)
List the names of any students or staff members who witnessed
the incident or enter "None" Verbal Warning Referral to Administrator

Written Warning Detention

Time-Out Suspension

Parent/Guardian Contacted Other (please specify)

Disruptive Behavior Describe any additional


actions taken not listed above

Description of Incident Follow-Up Actions


Type of Behavior (check all that apply) Follow-Up Plan
Enter the specific actions to be taken after the incident, such as a
Verbal Aggression Disruptive Behavior parent-teacher meeting, student counseling or monitoring behavior
Physical Aggression Defiance/Disobedience changes.

Bullying/Harassment Other (please specify)


Describe other behavior
not listed, if applicable

Detailed Description of Incident Next Review Date (if applicable) MM/DD/YYYY or N/A if not needed
Provide a clear, concise account of the incident. Include key facts,
actions and any relevant context about what occurred. You can
also describe what happened before and after the behavior.

Reported by Reviewed by Administrator


Name Name of the teacher or staff member Name Name of the reviewing administrator

Signature Signature

Date MM/DD/YYYY Date MM/DD/YYYY

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