Classroom Documentation Forms

📋 Classroom Behavior Action Documentation Form

Teacher Name: __________________________
Date: ______ / ______ / __________
Time of Incident: ______________________
Grade/Subject: _________________________
Student Name: __________________________

1. Behavior Concern (Check all that apply):

☐ Off-task behavior
☐ Disruptive behavior
☐ Defiance or non-compliance
☐ Inappropriate language
☐ Physical/verbal aggression
☐ Unkind behavior toward peers
☐ Other: _______________________________

2. Location:

☐ Classroom
☐ Hallway
☐ Cafeteria
☐ Playground
☐ Special Area
☐ Other: _______________________________

3. Actions Taken (Progressive Responses – Check all that apply and note date):

☐ Verbal redirection or reminder of expectations – Date: ____________
☐ Proximity control / non-verbal cue – Date: ____________
☐ Loss of privileges or class incentives – Date: ____________
☐ Reteaching of appropriate behavior – Date: ____________
☐ Parent/Guardian contact (Phone, Email, Note) – Date: ____________
☐ Classroom-based reflection or behavior contract – Date: ____________
☐ Referral to office or removal from classroom – Date: ____________

4. Brief Description of Incident and Actions Taken:

(What happened? How did the student respond? What support was provided?)

5. Follow-Up Needed?

☐ No

☐ Yes – Specify: ________________________________________