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    617 views1 page

    Abc Data Checklist

    Uploaded by

    api-367840577

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    KD 11/04

    ABC Checklist

    Student Name (D.O.B.): ____________________________________ School / Building: _________________________________

    Date Time Antecedent Behavior Consequence Duration Intensity


    What was happening before the What happened after? How long did the
    behavior occurred? behavior last?
    _____ Alone _____ Refusing to follow instructions _____ Student ignored ____ <1 minute 1 LOW
    _____ With peers _____ Disrupting class (describe) _____ Used proximity control ____ 1-5 minutes
    _____ Riding in bus/van _____ Making verbal threats _____ Gave a nonverbal cue ____ 5-10 minutes 2
    _____ Preparing for outing _____ Hurting self _____ Gave a verbal warning ____ 10-30 min.
    _____ Just ending an activity _____ Destroying property _____ Changed assignment ____ 1/2 1 hour 3
    _____ Participating in group _____ Screaming/yelling _____ Redirected ____ 1-2 hours
    _____ Asked to do something _____ Biting _____ Student lost privilege ____ 2-3 hours 4
    _____ Asked/told not to _____ Throwing _____ Sent to office ____ 3+ hours
    _____ Transitioning _____ Kicking _____ Suspended 5 HIGH
    _____ Working on academics _____ Running away _____ Gave detention
    (which one(s)?______________) _____ Grabbing/pulling _____ Gave a time out
    _____ At recess _____ Crying Loudly _____ Physical assist/prompt
    _____ Being ignored _____ OTHER (describe) _____ Physical escort
    _____ At lunch _____ Physical management
    _____ Given a warning _____ OTHER
    _____ About to begin new activity
    _____ OTHER (describe)

    NOTES:

    Date Time Antecedent Behavior Consequence Duration Intensity


    What was happening before the What happened after? How long did the
    behavior occurred? behavior last?
    _____ Alone _____ Refusing to follow instru ctions _____ Student ignored ____ <1 minute 1 LOW
    _____ With peers _____ Disrupting class (describe) _____ Used proximity control ____ 1-5 minutes
    _____ Riding in bus/van _____ Making verbal threats _____ Gave a nonverbal cue ____ 5-10 minutes 2
    _____ Preparing for outing _____ Hurting self _____ Gave a verbal warning ____ 10-30 min.
    _____ Just ending an activity _____ Destroying property _____ Changed assignment ____ 1/2 1 hour 3
    _____ Participating in group _____ Screaming/yelling _____ Redirected ____ 1-2 hours
    _____ Asked to do something _____ Biting _____ Student lost privilege ____ 2-3 hours 4
    _____ Asked/told not to _____ Throwing _____ Sent to office ____ 3+ hours
    _____ Transitioning _____ Kicking _____ Suspended 5 HIGH
    _____ Working on academics _____ Running away _____ Gave detention
    (which one(s)?______________) _____ Grabbing/pulling _____ Gave a time out
    _____ At recess _____ Crying Loudly _____ Physical assist/prompt
    _____ Being ignored _____ OTHER (describe) _____ Physical escort
    _____ At lunch _____ Physical management
    _____ Given a warning _____ OTHER
    _____ About to begin new activity
    _____ OTHER (describe)

    NOTES:

    This form created by: Kelly Dunlap, Psy.S., School Psychologist/Positive Behavior Support Consultant

    14

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