Student Observation Form

Student: C----- Location: Reading class Date Conducted: 3/30/22

Observer Name/Role: Ms. Hernandez Time: Duration:

Student’s academic or behavioral area(s) of concern:

Behavior, social cues.

Summarize the activities during the observation (lecture, independent work, group work, etc.):

Lecture was given by Mrs. Parker about a reading. They participated, which allowed more
movement or permission to speak.

Based on the observation, summarize how the student’s area(s) of concern are impacting the
student’s performance in the classroom, both academically and behaviorally. (List how the
student participated with curriculum content/materials, group or individual instruction,
teacher interaction/direction, interaction with peers, or independent work, etc.):

He is very fidgety and might distract other students when he tries to play around with them or
grab them. He stands up a lot and makes noises, which prevents him to pay attention
sometimes. He does seem to do his work and is friendly but might get frustrated easily with his
peers if they take too long doing something. He does well in general, but is part of the
resource room special services for reading and spelling. His reading problems might have to do
with him getting distracted easily or impatience. He might hit others in a playful way or pat his
peers heads, which is not always welcome.

List any special occurrences (e.g. Fire drill, other student’s behavior, teacher behavior,
substitute teacher, other adults in classroom, special events etc.):

There wasn’t any special occurrence. He behaved very well today.

Feedback, suggestions, or need for additional information:

Behavior Observation Form

Target Student ____C-----________ M/F __M__ Grade __5th__

School ____Madison M. School____ Teacher _____Mrs. Parker____ Date ___3/30/2022___
Observer __Ms. Hernandez__ Position ________
Class Activity __reading class____

Teacher directed whole class Teacher directed small group Independent work section

DIRECTIONS: Each box represents a ten-second interval. Observe each student once: then record the data.
This is a partial interval recording. If possible, collect full 15 minutes under teacher directed of independent
conditions. If not, put a slash when classroom conditions change.
Classmates observed must be the same sex as the target student.

Target Student
/ / i P O I P P / / / / T / / / / /
/ / / / / / / / / / / / / / / / / /
Classmate 1 2 3

Target Student
/ / / / T / T / / / / / / / / / / /
/ / / T / / / / / T / / / / / / / /
Classmate 1 2 3

Target Student
/ / / / / / / / / / / P / P / / / /
/ / / / / / / / / / T / / / / / / /
Classmate 1 2 3

Target Student
/ / / / / / / / / / / T / / / / / /
/ P / / / / / T / / / T / / / / / /
Classmate 1 2 3

Target Student
- / / T T / /
/ / / / / T /
Classmate 1

Note: To observe class-begin with the same sex student in row 1. Record each subsequent same sex student
in following intervals. Data reflect an average of classroom behavior. Skip unobservable students.

ON-TASK =eye contact with teacher or on-task and performing the requested task.

OFF-TASK=
T: talking out/noise – inappropriate verbalizing or making sounds with object, mouth, or body.
O: Out of seat – student fully or partially out of assigned seat without teacher permission
I: Inactive – student not engaged with assigned task and passively waiting, sitting, etc.
N: Noncompliance – breaking a classroom rule or not following teacher direction within 15 seconds.
P: Playing with object – manipulating objects without teacher permission.
OTHER CODES (to be done in addition to on- and off-task codes) =
+ : Positive teacher interaction – one on one positive comment, smiling, touching, or gesture.
- : Negative teacher interaction – one on one reprimand, implementing negative consequence or negative
gesture.

Comments/Notations:
 Student Observation Form

Student: W------ Location: Spelling class Date Conducted: 3/30/22

Observer Name/Role: Ms. Hernandez Time: Duration:

Student’s academic or behavioral area(s) of concern:

Behavior, social cues.

Summarize the activities during the observation (lecture, independent work, group work, etc.):

Lecture and independent work

Based on the observation, summarize how the student’s area(s) of concern are impacting the
student’s performance in the classroom, both academically and behaviorally. (List how the
student participated with curriculum content/materials, group or individual instruction,
teacher interaction/direction, interaction with peers, or independent work, etc.):

He is a very talkative student, but very friendly. One student complained about him being
“mean” towards him. I observed how he interacts with others.
He can get distracted easily and even try to talk to the teacher individually about something off
topic. He sometimes speaks to students across the room. Likes to help the teacher and do
active things.

List any special occurrences (e.g. Fire drill, other student’s behavior, teacher behavior,
substitute teacher, other adults in classroom, special events etc.):
NA

Feedback, suggestions, or need for additional information:

Behavior Observation Form

Target Student ____W------________ M/F __M__ Grade __5th__

School ____Madison M. School____ Teacher ______Mrs. Parker____ Date ___3/30/2022___
Observer __Ms. Hernandez__ Position ________
Class Activity __spelling class____

Teacher directed whole class Teacher directed small group Independent work section

DIRECTIONS: Each box represents a ten-second interval. Observe each student once: then record the
data. This is a partial interval recording. If possible, collect full 15 minutes under teacher directed of
independent conditions. If not, put a slash when classroom conditions change.
Classmates observed must be the same sex as the target student.

Target Student
T O T T / / / / / / / / / T T / / /
T / / / / T T T / / / / / / / / / /
Classmate

Target Student
/ / / T / T / / T / / / / / / / i /
/ / / / T T / / / / / / / / / / / /
Classmate

Target Student
/ T / / / / / / / / / / / / / / / /
/ / / / / / / / / / / / / / / / / /
Classmate

Target Student
/ / / / / / / / T T / / / / T / / /
/ / / / T / / / / / / T / / / T / /
Classmate

Target Student
T / T / / / / / / / / / / / / / / /
/ / T T / / / / T / / / / / / / / /
Classmate

Note: To observe class-begin with the same sex student in row 1. Record each subsequent same sex
student in following intervals. Data reflect an average of classroom behavior. Skip unobservable
students.

ON-TASK =eye contact with teacher or on-task and performing the requested task.

OFF-TASK=
T: talking out/noise – inappropriate verbalizing or making sounds with object, mouth, or body.
O: Out of seat – student fully or partially out of assigned seat without teacher permission
I: Inactive – student not engaged with assigned task and passively waiting, sitting, etc.
N: Noncompliance – breaking a classroom rule or not following teacher direction within 15 seconds.
P: Playing with object – manipulating objects without teacher permission.

OTHER CODES (to be done in addition to on- and off-task codes) =

+ : Positive teacher interaction – one on one positive comment, smiling, touching, or gesture.
- : Negative teacher interaction – one on one reprimand, implementing negative consequence or
negative gesture.

Comments/Notations: