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KIBL, OTRP SWU-PHINMA OT

Classroom Behavior Checklist


NAME OF CHILD:
Expected Behavior Monday Tuesday Wednesday Thursday Friday

Listened in Class or to the


Teacher/Showed respect

Participated in Class

Raised hand before speaking

Did not yell /speak loudly/use


inappropriate words

Stay seated or in place

Followed instructions

Started and finished the


activity

Did not hurt others/disturb


others

Waited for his/her turn

Teacher’s Comments: ___________________________________________


____________________________________________________________________

REWARD/POSITIVE REINFORCEMENT

NEGATIVE REINFORCEMENT

Teacher-in-charge: ______________________
KIBL, OTRP SWU-PHINMA OT
Therapist-in-charge: ______________________
KIBL, OTRP SWU-PHINMA OT

Home Behavior/Routine Checklist


NAME OF CHILD:
Expected Behavior Monday Tuesday Wednesday Thursday Friday

Woke up early or/on time for


school

Helped in preparing for school

Ate meals independently

Helped in doing household


chores

Started and finished the school


work activity/homework

Play time with other kids


outside

Listened to parents
instructions

Did not hurt others/disturb


others

Did not yell /speak loudly/use


inappropriate words

Waited for his turn

Parent’s Comments: ___________________________________________


____________________________________________________________________

REWARD/POSITIVE REINFORCEMENT

NEGATIVE REINFORCEMENT

Therapist-in-charge: _____________________
KIBL, OTRP SWU-PHINMA OT

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