Understanding the Behaviour Checklist

Understanding My Behaviour

Name: Antecedent Behaviour Consequence (Before the event) (During the event) (After the event) DESCRIBE WHAT OCCURRED BEFORE THE DESCRIBE WHAT THE PERSON DID DURING DESCRIBE WHAT HAPPENED AFTER INCIDENT: THE INCIDENT……………………………………. THE INCIDENT…………………………….... …………………………………………….. ……………………………………………………… ………………………………………………… ……………………………………………………… ……………………………………………………… ………………………………………………… ….. ……………………………………………………… ………………………………………………… ……………………………………………………… ……………………………………………………… ………………………………………………… ….. ……………………………………………………… ………………………………………………… ……………………………………………………… Behaviours: (circle) Things that happened after: (circle) ….. ……………………………………………………… swearing refusing to work arguing punished isolated time-out …..…………………………… Triggers: (circle) run away upset demanding fighting suspended sent away went for a walk new person change in routine crowded place not following directions hiding walking around removal of desired object/activity teasing bullying left alone new activity hurting myself hurting others biting friends approval bullied or teased not get what I want noise lack of choice rocking damaging objects throwing objects get attention clean up the mess I made hungry called me names on way to school pacing lining up/ordering objects staring re-direction told the rule left alone room temperature weather assembly time annoying others vomiting touching Ignored get what I wanted principal

Where did the behaviour occur? (circle) extremely upset yelling/screaming stealing hurt others damaged property police called Other:……………………………………………………. parents/carers called sent to another class own room other room classroom library How long did I do this? ………………………… sat in the office playground excursion vehicle toilets How bad was my behaviour? Who was present?...... Other: ……………………………………………………… Low Medium High ………………………………………...... ……………………………………………………… ...... ………………………………………………………......

Was I cranky before this happened?

Yes No How long?......