Behavior Checklist

Student Name: Teacher:

 PoorAttention/
Inappropriate
Disruptive Social
Manipulative
Withdrawn
Aggressive Concentration
Behavior

Occasional

Frequently
Does
Does notother
not follow
initiate oral or
play lessons…………………………………………………………….
talk
,tired……………………………………………………………………………. with peers………………………………………………...

Almost
Attacks children by hitting,shoving,etc………………………………………….

Never
Please
Does
Wants
Seems
Verbally
Is mark
not bythe
ollow
excessive
generally
avoided attacks frequency
lessons
peersvisits
and to
atprovokesthat
onthe
board theorfvisual
ollowing behaviors are displayed in your class.
materials…………………………………..
bathroom…………………………………………………
unhappy……………………………………………………………….
other children…………………………………………..
school……………………………………………………………

ly
Rarely
Works
Stares
Personal completes
only
blankly
Hyperactive whenintoany
appearance isassignments……………………………………………………..
given individual
lacking help………………………………………………...
space………………………………………………………………...
Steals……………………………………………………………………………………. in cleanliness,order……………………………………
Daydreams……………………………………………………………………………….
Blames
Rarely
Explosive
Does
Out ofnot mistakes
asksorforangry
functionin onwhen
anything
assistance
group even
things but
or class
seat……………………………………………………………………………… doself(directions,sizeofbook,
when notwork is too
go own etc.)………………….
difficult……………………………..
way……………………………………
discussions………………………………………...
Easily
Does
Argues distracted
Constantly
not
Ridicules puts
attempt
with the from
self down
teacher task
peers, …………………………………
Constant movement overby
or ordinary
criticizes classroom
own
work………………………………………………………………….. stimuli (minormovement,
work………………………………………
behavior………………………………………………….
in desk……………………………………………………………. noises)…
Tries
Avoids to keep
calling
Destructive
Can’t remain you offtask
attention by talking about otherthings,etc.
to self………………………………………………………….
ofinothers’belongings
line to and .………………………….
and schoolwork……………………………………..
from classes………………………………………………..
Approaches
Strikes back new
with tasks,situations
angry behavior with“Ican’t doit.”or“It’stoohard.”……………...
to teasing…………………………………………….
Constant verbal behavior……………………………………………………………….
Has nervous muscle twitches,eye-blinking,nail-biting,etc. …………………………..

Doesn’t follow class or school rules(quiet,on time,etc.)………………………………

Interrupts lessons by antics(verbal or physical)………………………………………...

Uncooperative
Blames others for own mistakes………………………………………………………...
Will not follow routines…………………………………………………………………
Works only when threatened with punishment…………………………………………
Defiant of teacher’s requests……………………………………………………………
Argues with peers over minor situations……………………………………………….