Child’s Initials: _______________ Recording Staff: _________________ Date: _____________________ Time of Occurrence _________________ What Happened Before? Describe the Behavior Like a What Happened After? (Possible Trigger) Camera Sees It (Form) (Maintaining Consequences) Possible motivation/function (Check all that seem possible) Obtain Desired Item Express Emotion Avoid Task Obtain Desired Activity Initiate Social Interaction Adults Get Sensory Stimulation Avoid Sensory Stimulation Avoid Peers Gain Connection to Person Avoid Attention Other ________________ Location of Occurrence (Check one) Assigned Classroom Hallway Field Trip Playground Bathroom Office Cafeteria Other Classroom Other ________________ Activity (Check one) Arrival Meals Departure Classroom Jobs Quiet Time/Nap Transition Centers/Work Time Outdoor Play Individual Activity Small Group Activity Special Activity Other___________________ Large Group Activity Self-Care Others Directly Involved (Check all that apply) Teacher Family Member Peers/Classmates Assistant Teacher Support/Administrative Staff Initials __________________ Substitute Other_____________________ What happened after? What did others do? (Check all that apply even if listed above) Obtained Object/Activity Ignore the Behavior Redirection Removal of Item Verbal Reminder Time with Adult Removed from Activity Visual Reminder Removed from Class Peers Move Away Use of Social-Emotional Family Contact Away from Peer/Adult Teaching Strategy Other_______ Physical Guidance Comments*: Instructions for Completing Behavior Observation Report
Child’s Initials: _______________ Recording Staff: _________________ Date: _____________________ Time of Occurrence _________________ What Happened Before? (Possible Trigger) Describe the Behavior Like a Camera Sees It (Form) What Happened After? (Maintaining Consequences) Possible motivation/function (Check all that seem possible) Obtain Desired Item Obtain Desired Activity Get Sensory Stimulation Gain Connection to Person Express Emotion Initiate Social Interaction Avoid Sensory Stimulation Avoid Attention Avoid Task Adults Avoid Peers Other ________________ Location of Occurrence (Check one) Assigned Classroom Playground Cafeteria Hallway Bathroom Other Classroom Field Trip Office Other ________________ Activity (Check one) Arrival Classroom Jobs Centers/Work Time Small Group Activity Large Group Activity Meals Quiet Time/Nap Outdoor Play Special Activity Self-Care Departure Transition Individual Activity Other___________________ Others Directly Involved (Check all that apply) Teacher Assistant Teacher Substitute Family Member Support/Administrative Staff Peers/Classmates Initials __________________ Other_____________________ What happened after? What did others do? (Check all that apply even if listed above) Obtained Object/Activity Removal of Item Removed from Activity Peers Move Away Away from Peer/Adult Ignore the Behavior Verbal Reminder Visual Reminder Use of Social-Emotional Teaching Strategy Physical Guidance Redirection Time with Adult Removed from Class Family Contact Other_______ Comments*: Instructions for Completing Behavior Observation Report
SETA-BOR-English.docx