ABA Checklist for the Classroom

Directions: Check off all items that apply. Leave blank items that do not apply. Please return to point person when full.
Target behaviour:

Date
Time
Occurrence # 1 2 3 4 5 6 7 8 9 10
Teacher initials
Events
Not wanting to come to school/comes to school
mad
Tired
Sick, lethargic
Other:
Antecedents
Minutes earned
Classwork (independent/worksheet)
Classwork (small or large group)
Following an expectation/direction
Challenge with a classmate
Other:
Location/Activity
Classroom
Outside
Break out room
Hallway
Art or Music
Other
Behaviour
Negative statement (S = self / O = others)
Physical outburst (self/others)
Leaves room (w/o permission)
Refuses to leave the classroom/activity
Throwing objects
Other:
Consequence
Repeated direction/provided a choice/reminder
of what he is working for
Cue to take a break
1:1 Debrief
Peers provided attention (reaction)
Peers ignored (no reaction)
Outcome
Returned to activity (w/o further disruption)
Asked for alone time
Left room with/disruption
Left room without disruption
Other:
COMMENTS: