Daily Behavior Incident Reports
Student name (Last, First)
Yellow Card Referral
Inappropriate Language (e.g. cursing, jokes, slander, off task)
Physical Contact (e.g. play fighting, minor shoving,)
Non-Compliance (e.g. not following directions during work time, transitions, time out)
Class Disruption (e.g. talking after redirection, talking back to teacher, out of seat, yelling out)
Lying/Cheating (e.g. looking on peer's screen, paper)
Throwing Objects (e.g. milk containers, paper, pencils, erasers)
Late to class (e.g. stopping at bathroom without permission, arriving without a pass)
Walking out of class (e.g. going to locker, bathroom, nurse, office without permission)
Yellow Card Result
Red Card Referral
Third Warning (2 yellow cards perviously given)
Abusive/Inappropriate language toward staff or peer (e.g. swearing, name calling, aggressive talking back,)
Fighting (e.g. physical, verbal, major pushing, major shoving)
Major Disrespect/Insubordination (e.g. 3 time refusal to work, move, leave the room, take a time out, sit silently_
Major Classroom Disruption (e.g. refusal to leave the room, tantrum)
Bullying (e.g. excessive targeting of another student)
Questions for Student
What made you upset (elementary level)? What were you trying to get? (middle level)
What did you do because you were upset? (elementary level) How did you try to get what you wanted? (middle level)
How did you feel after? (elementary level) Did it work? (middle level)
What will you do in the future if this happens again? (elementary level) What could you have done to get what you wanted? (middle level)
Which types of behavior did you exhibit?
Yelling out at inappropriate times
Defiance (refusal to follow directions)
Punching/kicking/hitting/slapping another student
Destruction of school property
Aggressive language (towards another student)
Aggressive language (towards teacher)
Refusal to take a time out
Talking back when teacher gives a direction
Threatening behavior that makes others feel unsafe
Questions for Teacher
What happened leading up to the behavior?
What behavior(s) did the student exhibit?
What steps did you take to respond to the behavior?
Will you contact the parent concerning the behavior issue?
Yes, I will
Yes, I all ready did
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