Stimulus Response Data Sheet

Learner: ______Skill: Independent Work Criteria: ______Chaining Procedure: ______

Instructions: Create a stimulus response chain with the SD and consequence listed for each response. Record the prompt level for each response (total task), or current target step (backward chain or forward chain). Date Step SD / Consequence Response # Baseline NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S ___”Go do your work”______FP FP FP 1 Walks to work area PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ____In front of work area_____ IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S ___In front of work area______FP FP FP 2 Pulls out chair PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ____Chair is out______IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Chair is out______FP FP FP 3 Sit Down PP PP PP PP PP PP PP PP PP PP PP PP PP PP C _____Sitting in chair______IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Sitting in chair______FP FP FP 4 Turn to face drawers PP PP PP PP PP PP PP PP PP PP PP PP PP PP C _____Facing drawers______IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Facing Drawers______FP FP FP 5 Pull out Drawer # 1 PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Drawer # 1 pulled out____ IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Drawer # 1 pulled out___ FP FP FP 6 Take contents out of PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Contents in hand_____ drawer # 1 IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Contents in Hand______FP FP FP 7 Set up contents to PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Contents set up______complete task IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Contents set up______FP FP FP 8 Complete Task PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Task complete______IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Task complete______FP FP FP 9 Return task to PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Task contents in drawer___ drawer # 1 IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S ____Task contents in drawer_ FP FP FP 10 Close Drawer # 1 PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Drawer # 1 closed______IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Drawer # 1 closed______FP FP FP 11 Pull out Drawer # 2 PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Drawer # 2 pulled out__ IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Drawer # 2 pulled out_____ FP FP FP 12 Take contents out of PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Contents in hand______drawer # 2 IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Contents in Hand______FP FP FP 13 Set up contents to PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Contents set up______complete task IND IND IND IND IND IND IND IND IND IND IND IND IND IND

Date Step SD / Consequence Response # Baseline NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Contents set up______FP FP FP 14 Complete Task PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Task complete______IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Task complete______FP FP FP 15 Return task to PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Task contents in drawer_ drawer # 2 IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S ____Task contents in drawer_ FP FP FP 16 Close Drawer # 2 PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Drawer # 2 closed______IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Drawer # 2 closed______FP FP FP 17 Pull out Drawer # 3 PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Drawer # 3 pulled out__ IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Drawer # 3 pulled out____ FP FP FP 18 Take contents out of PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Contents in hand______drawer # 3 IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Contents in Hand______FP FP FP 19 Set up contents to PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Contents set up______complete task IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Contents set up______FP FP FP 20 Complete Task PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Task complete______IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Task complete______FP FP FP 21 Return task to PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Task contents in drawer___ drawer # 3 IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S ____Task contents in drawer__ FP FP FP 22 Close Drawer # 3 PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Drawer # 3 closed______IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Drawer # 3 closed______FP FP FP 23 Pull out Drawer # 4 PP PP PP PP PP PP PP PP PP PP PP PP PP PP C _____Drawer # 4 pulled out____ IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Drawer # 4 pulled out____ FP FP FP 24 Take contents out of PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Contents in hand______drawer # 4 IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Contents in Hand______FP FP FP 25 Set up contents to PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Contents set up______complete task IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Contents set up______FP FP FP 26 Complete Task PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Task complete______IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Task complete______FP FP FP 27 Return task to PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ____Task contents in drawer_____ drawer # 4 IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S ____Task contents in drawer__ FP FP FP 28 Close Drawer # 4 PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Drawer # 4 closed______IND IND IND IND IND IND IND IND IND IND IND IND IND IND Date Step SD / Consequence Response # Baseline NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Drawer # 4 closed_____ FP FP FP 29 Pull out Drawer # 5 PP PP PP PP PP PP PP PP PP PP PP PP PP PP C _____Drawer # 5 pulled out___ IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Drawer # 5 pulled out_____ FP FP FP 30 Take contents out of PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Contents in hand______drawer # 5 IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Contents in Hand______FP FP FP 31 Set up contents to PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Contents set up______complete task IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Contents set up______FP FP FP 32 Complete Task PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Task complete______IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Task complete______FP FP FP 33 Return task to PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Task contents in drawer___ drawer # 5 IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S ____Task contents in drawer__ FP FP FP 34 Close Drawer # 5 PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Drawer # 5 closed______IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Drawer # 5 closed______FP FP FP 35 Pull out Drawer # 6 PP PP PP PP PP PP PP PP PP PP PP PP PP PP C _____Drawer # 6 pulled out______IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Drawer # 6 pulled out_____ FP FP FP 36 Take contents out of PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Contents in hand_____ drawer # 6 IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Contents in Hand_____ FP FP FP 37 Set up contents to PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Contents set up______complete task IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Contents set up______FP FP FP 38 Complete Task PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Task complete______IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Task complete______FP FP FP 39 Return task to PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Task contents in drawer___ drawer # 6 IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S ____Task contents in drawer__ FP FP FP 40 Close Drawer # 6 PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ______Drawer # 6 closed_____ IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____ Drawer # 6 closed_____ FP FP FP 41 Turn to face table PP PP PP PP PP PP PP PP PP PP PP PP PP PP C ____ Facing Table______IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____Facing Table______FP FP FP 42 Raise Hand PP PP PP PP PP PP PP PP PP PP PP PP PP PP C _____”Yes ______” ______IND IND IND IND IND IND IND IND IND IND IND IND IND IND NR NR NR D FP FP FP FP FP FP FP FP FP FP FP S _____ “Yes _____”______FP FP FP 43 “All Done” PP PP PP PP PP PP PP PP PP PP PP PP PP PP C _____Independent work is complete IND IND IND IND IND IND IND IND IND IND IND IND IND IND