Enter the student’s name and date.

Fill in the Daily Goal(s)—these should be behaviorally specific and personalized (e.g., “Stay on task,” “Use kind words”).

Determine the total possible points for the day (typically: 3 categories × # of periods × 2 points each).

At the end of each class or transition period, assign a score (0, 1, or 2) for each behavior:

• 2 = Met Expectations

• 1 = Partially Met Expectations

• 0 = Did Not Meet Expectations

Circle or check the score in each behavior column:

• Be Safe

• Be Respectful

• Be Responsible

Include a quick note if something notable occurred (positive or negative).

Initial or sign each row to confirm teacher input.

Add up all points earned.

Calculate the percentage:
(Points Earned/ Points Possible) ×100

Determine if the student met the daily goal (usually set at 80% or higher unless otherwise specified).

Take a few minutes to go over the form with the student:

• Celebrate successes.

• Identify 1–2 areas for growth.

• Help them fill in the Daily Reflection section.

Have the student bring the sheet home for a parent signature and optional comment.

Encourage them to return it the next day to build accountability.