ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
This File is VIEW ONLY. To add your data, print this page, or go to File--> Make a Copy.
2
ABC Data Checklist
3
4
Student:
ID #: _______________
5
6
7
School:
8
9
10
Date:
11
Time:
12
Staff Initials:
13
Behavior:
14
15
16
17
Location where behavior occurred: (Specify)
18
Classroom
19
Hallway
20
Cafeteria
21
Bus
22
Office
23
24
25
Persons Present:
26
Teacher
27
Peers
28
Specialists (SLP, OT, PT)
29
Administrator
30
Bldg Security
31
32
33
Activity:
34
Academic task
35
Nonacademic task
36
Breakfast/Lunch
37
Transition (activity/locations)
38
Directed break time/time out
39
Recess
40
Arrival/Dismissal
41
Restroom
42
43
44
Setting Events:
45
Sleepy/Sick/Hungry
46
Medication change/ no medication
47
Environmental factors (noise/crowds)
48
Work demands too difficult
49
Disruption in routine
50
51
52
Antecedents:
53
Work demand
54
Social interaction with staff/peer
55
Ignored by staff or peer
56
Activity/object removed or unavailable
57
Student request denied
58
Verbal redirection by adult
59
60
61
Consequences:
62
Staff/peer walked away
63
Staff/peer verbally engaged
64
Task stopped
65
Student verbally redirected
66
Choices offered
67
Alternate activity/object provided
68
Break offered
69
Additional staff called (crisis team)
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100