Free Child Behavior Incident Report Template
Child Behavior Incident Report
I. Introduction
This Child Behavior Incident Report focuses on documenting disruptive classroom behavior exhibited by a student. The purpose of this report is to provide a clear and comprehensive account of the incident, enabling appropriate follow-up actions and interventions.
II. Incident Report Details
1. Incident Information
|
Date: |
2050-09-15 |
|---|---|
|
Time: |
10:30 AM |
|
Location: |
Classroom 204 |
2. Student Information
|
Student Name: |
Ken Banks |
|---|---|
|
Age: |
10 years |
|
Grade Level: |
5th Grade |
3. Description of the Incident
At approximately 10:30 AM, during a math lesson in Classroom 204, Ken Banks began to disrupt the class by talking loudly and making inappropriate comments. Despite multiple verbal warnings from the teacher, Ken continued to engage in disruptive behavior, including throwing papers across the room and refusing to follow instructions.
4. Individuals Involved
|
Role |
Name |
|---|---|
|
Teacher |
[YOUR NAME] |
|
Students Involved/Witnesses |
Entire 5th-grade class |
5. Actions Taken
-
Verbal warnings were given to the student.
-
The student was asked to move to a different seat to minimize disruption.
-
The incident was documented for further review.
6. Witnesses
|
Name |
Role |
|---|---|
|
Penny Ford |
Student (classmate) |
|
Terry Jenkins |
Student (classmate) |
7. Follow-Up Actions
-
A meeting with Ken Banks' parents is scheduled for 2050-09-17 to discuss the incident and explore possible interventions.
-
Ken will be referred to the school counselor for further evaluation and support.
-
A behavior contract will be developed with Ken to address and improve his classroom behavior.
8. Signature
[YOUR NAME]
Teacher
Date: [DATE]
School: [YOUR COMPANY NAME]
Address: [YOUR COMPANY ADDRESS]
Contact Number: [YOUR COMPANY NUMBER]
Website: [YOUR COMPANY WEBSITE]
Social Media: [YOUR COMPANY SOCIAL MEDIA]
