Disruptive Behavior Incident Report

I. Reporter Information

Section	Details
Name:	[Your Name]
Email:	[Your Email]
Position:	Teacher
School Name:	[Your Company Name]

II. Incident Details

Section	Details
Incident Date	May 30, 2050
Incident Time	10:00 AM
Location	Classroom 101

III. Student Information

Section	Details
Student Name:	[Student Name]
Grade/Year:	4th Grade

IV. Incident Description

On May 30, 2050, at approximately 10:00 AM, the student, [Student Name], disrupted the classroom environment by yelling and refusing to follow instructions.

This behavior occurred during a Math lesson. Despite multiple warnings and requests to settle down, the student continued their disruptive behavior, causing significant distraction to other students in the class.

V. Actions Taken

Initially, I, [Your Name], attempted to calm the student with verbal warnings. When this proved ineffective, I paused the class to address the student's behavior directly, requesting that they cease yelling and follow instructions.

The student continued to refuse compliance. I then asked the student to step outside the classroom to discuss the matter further.

The student eventually complied with this request after several minutes and a call to the school administration was made to assist with further intervention.

VI. Witnesses

• Witness 1: [Teacher Assistant Name], Teacher Assistant

  • Witness Statement: "I observed [Student Name]'s disruptive behavior and can confirm the teacher's account."

• Witness 2: [Student Name], Student

  • Witness Statement: "I saw [Student Name] yelling and not listening to the teacher."

VII. Recommendations

Given the severity and recurring nature of the student's disruptive behavior, I recommend the following actions:

• A meeting with the student's parents or guardians to discuss behavioral expectations and consequences.

• Referral to the school's guidance counselor for ongoing support and behavior management strategies.

• Consideration of specific classroom behavior management plans tailored to the student's needs.

VIII. Reporter Signature

• Reporter Name: [Your Name]

• Date: May 30, 2050

Report Templates @ Template.net