Free Behavior Intervention Incident Report Template
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]
