Disruptive Behavior Incident Report
Disruptive Behavior Incident Report
I. Reporter Information
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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
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Witness 1: [Teacher Assistant Name], Teacher Assistant
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Witness Statement: "I observed [Student Name]'s disruptive behavior and can confirm the teacher's account."
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Witness 2: [Student Name], Student
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Witness Statement: "I saw [Student Name] yelling and not listening to the teacher."
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VII. Recommendations
Given the severity and recurring nature of the student's disruptive behavior, I recommend the following actions:
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A meeting with the student's parents or guardians to discuss behavioral expectations and consequences.
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Referral to the school's guidance counselor for ongoing support and behavior management strategies.
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Consideration of specific classroom behavior management plans tailored to the student's needs.
VIII. Reporter Signature
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Reporter Name: [Your Name]
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Date: May 30, 2050
