Functional Behavior Assessment Form
Functional Behavior Assessment Form
Please complete this form to help us address behavioral concerns.
Date
Individual's Name
Observer's Name
Relationship to Individual
Behavior Description
Frequency of Behavior
Duration of Behavior
-
Less than 5 minutes
-
5-10 minutes
-
10-15 minutes
-
15+ minutes
Triggers/Antecedents
When does the behavior typically occur?
Behavior Location
Where does the behavior usually happen?
Responses/Consequences
What typically happens after the behavior?
Have you tried any strategies to address the behavior?
Additional Notes
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