Student: ____________________ Potential Reinforcer Survey Date: ____________
Likes
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very Likes Unsure
like
much
Category 1
Consumable food reinforcers
Candy & Treats
chocolate
gum
gumdrops
jelly beans
lollipops
mints
raisins
fruit chews
gummy bears
M&Ms
Fruit
apples
bananas
grapes
oranges
berries
Drinks
juice; type:
water
milk
soda; type:
flavored water; type:
Snacks
chips
cookies
crackers
Goldfish
ice cream
peanuts
popcorn
Additional food items
Copyright © 2014 by Behavior Analysts, Inc. Page 1 of 13
Student: ____________________ Potential Reinforcer Survey Date: ____________
Likes
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very Likes Unsure
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much
Copyright © 2014 by Behavior Analysts, Inc. Page 2 of 13
Student: ____________________ Potential Reinforcer Survey Date: ____________
Likes
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very Likes Unsure
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Category 2
Reinforcing activities in relation to
first category consumables
baking projects (i.e., cookies)
cleaning up following distribution of rfrs
distributing (passing out) reinforcers
popping popcorn
preparing snacks
scooping ice cream
Additional activities
Category 3
Tangible reinforcers other than food
special materials | crayons pencils
colored chalk
sidewalk chalk
markers
feathers
toys, games, prizes (from a store)
spinning tops
gadgets that light, whistle, play music,
spin, etc.
Additional tangible reinforcers
Category 4
Token reinforcers
checks and/or points
happy faces and/or achiever's chart
Copyright © 2014 by Behavior Analysts, Inc. Page 3 of 13
Student: ____________________ Potential Reinforcer Survey Date: ____________
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like
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rubber stamp marks, various designs
stars next to name on chart
stickers
Additional token items
Copyright © 2014 by Behavior Analysts, Inc. Page 4 of 13
Student: ____________________ Potential Reinforcer Survey Date: ____________
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very Likes Unsure
like
much
Category 5
Activity reinforcers
Games
bingo
Blockhead
cards | specify game:
checkers
chess
crossword puzzles
dominos
Candy Land
Life
lotto games
Monopoly (junior or regular)
number games
Sorry
Throw and add
Tiddlywinks
Tip-it
word games
Yahtzee
Additional games
Academic-type activities
alphabet activities
lacing activities
number activities
puzzles | cardboard
puzzles | foam
puzzles | wooden
reading | books, magazines, comic books
shape sorters
sorting | colors, shapes, objects,
categories
stringing beads
tops
Additional activities
Copyright © 2014 by Behavior Analysts, Inc. Page 5 of 13
Student: ____________________ Potential Reinforcer Survey Date: ____________
Likes
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much
Copyright © 2014 by Behavior Analysts, Inc. Page 6 of 13
Student: ____________________ Potential Reinforcer Survey Date: ____________
Likes
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very Likes Unsure
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Arts and crafts
colored pens or pencils
coloring books
coloring, printing, drawing
dot-to-dot
finger painting
making bead jewelry
making things | kites, model cars or
airplanes
painting
Play-doh or clay
shaving cream
sidewalk chalk
writing | chalkboard/whiteboard
Additional arts and crafts
Thematic play
"Matchbox"-type cars
cars and trucks
doll house (miniatures)
dolls
dress up
kitchen play (pretend)
puppets
trains
Additional theme play activities
Copyright © 2014 by Behavior Analysts, Inc. Page 7 of 13
Student: ____________________ Potential Reinforcer Survey Date: ____________
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Active games
beanbags
circle games
climbing play structure
climbing trees
Frisbee
gliders
hopscotch
jacks
jump rope
jumping
kites
marbles (if appropriate)
marble roll games
outdoor walks
parachute
roller skating
sand play
sliding
spinning games
swinging
trampoline
water play
yo-yo
bike riding
scooter boards
Additional active activities
Blocks and building
blocks | foam
blocks |wood
Lego's
Lincoln logs
Tinker toys
Additional blocks and building activities
Copyright © 2014 by Behavior Analysts, Inc. Page 8 of 13
Student: ____________________ Potential Reinforcer Survey Date: ____________
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Copyright © 2014 by Behavior Analysts, Inc. Page 9 of 13
Student: ____________________ Potential Reinforcer Survey Date: ____________
Likes
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very Likes Unsure
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much
Music and auditory
books on tape
books with auditory input
listening to music
singing
sound lotto
recording devices
videos via DVDs, iPhone, iPad, computer
musical instruments
Additional music and auditory activities
Science and nature
bubbles
exploration with water
gardening
magnets
Pin screen
Balance and pendulums
Additional science and nature activities
Physical/social
tickles
hugs
high 5's
loud praise
clapping
cheering
"airplane" rides
chase games
hide and seek
hip hip hooray
piggy back rides
dancing
Additional physical/social activities
Copyright © 2014 by Behavior Analysts, Inc. Page 10 of 13
Student: ____________________ Potential Reinforcer Survey Date: ____________
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much
Copyright © 2014 by Behavior Analysts, Inc. Page 11 of 13
Student: ____________________ Potential Reinforcer Survey Date: ____________
Likes
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Other favorites
favorite characters
favorite items and/or themes
favorite songs and/or fingerplays
favorite toys
favorite TV programs
favorite videos
Copyright © 2014 by Behavior Analysts, Inc. Page 12 of 13
Student: ____________________ Potential Reinforcer Survey Date: ____________
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