Behavior Intervention Incident Report

Behavior Intervention Incident Report


I. Incident Details

Date of Incident

Time of Incident

Location

May 15, 2060

10:30 AM

Classroom 203

II. Student Information

Name

Grade

Date of Birth

Emily Jones

5th Grade

January 10, 2052

III. Description of Behavior

Emily repeatedly disrupted the class by talking loudly and refusing to follow instructions during a math lesson.

IV. Immediate Response

The teacher redirected Emily to a quiet area in the classroom and provided her with alternative assignments to complete independently.

V. Intervention Plan

An intervention plan will include:

  • Scheduled breaks to help Emily refocus.

  • Positive reinforcement strategies to encourage appropriate behavior.

VI. Follow-Up Actions

Following the incident, the teacher will:

  • Monitor Emily's behavior closely during future math lessons.

  • Adjust the intervention plan as needed based on Emily's response and progress.

VII. Outcome/Evaluation

The initial implementation of the intervention plan resulted in:

  • Improved focus and engagement from Emily during math lessons.

  • Continued evaluation is necessary to determine the long-term effectiveness of the plan.

VIII. Recommendations

To further support Emily's behavior, it is recommended to:

  • Involve Emily's parents in developing additional strategies to address her attention-seeking behavior.

  • Collaborate with the school counselor or behavior specialist to explore further interventions if needed.

IX. Parent/Guardian Communication

A meeting will be scheduled with Emily's parents to:

  • Discuss the incident and the intervention plan.

  • Seek their input and collaboration in supporting Emily's behavior in the classroom.

X. Signature

[YOUR NAME], Teacher In-Charge

Date: [DATE]

Report Templates @ Template.net