Teacher Behavior Log

 

Student Name: ________________________                                                      Teacher: ___________________

                 

Date: ____________ Time: _________ am/pm           Setting: _____________________

 

Description of incident: (what happened, who was involved, during what activity, what triggered it, what was the outcome). ___________________________________________________________________________________          ____________________________________________________________________________________________

____________________________________________________________________________________________

 

Duration: _______ # of minutes.                                     Intensity: low   med.   high

 

Was Time-out required: Yes   No; If so how long _________

 

Comments:

 

 

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Date: _____________ Time: _______ am/pm                             Setting: ________________

 

Description of incident: (what happened, who was involved, during what activity, what triggered it, what was the outcome). ___________________________________________________________________________________          ____________________________________________________________________________________________

____________________________________________________________________________________________

 

Duration: _______ # of minutes.                                     Intensity: low   med.   high

 

Was Time-out required: Yes   No; If so how long _________

 

Comments:

 

 

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Date: ____________ Time: _______ am/pm                                               Setting:_________________

 

Description of incident: (what happened, who was involved, during what activity, what triggered it, what was the outcome). ___________________________________________________________________________________          ____________________________________________________________________________________________

____________________________________________________________________________________________

 

Duration: _______ # of minutes.                                     Intensity: low   med.   high

 

Was Time-out required: Yes   No; If so how long _________

 

Comments:

 

 

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Copyright 2001, J.L. McDougal

 

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