BEHAVIOR  OBSERVATION  TOOL  

Class/Setting​  ​(context):    
 __Assembly    __Classroom        __Bathroom        __Computer  Lab        __Gym/P.E.    __Hallway(s)        __Library/Media        __Music  
 __Outside/Playground              __  Cafeteria            __Bus        __Other:____________________________________  
Date:_____________________          Time:_______________          Observer(s):__________________________________________________  
 
ANTECEDENTS   BEHAVIOR  of  CONCERN   CONSEQUENCES  
Curricular/Instructional   Behavior  1​:   Escape  Related  Consequences  
__​__Difficult  or  new  task/work     ____No  adult  or  peer  response  
____Routine  task              (no  eye  contact,  verbalization,  etc)  
____Written  work  required     ____Head  on  desk  
____Teacher  directing  group  lesson     ____Isolated  lunch/instruction  
____Lack  prior  knowledge     ____Send  out  of  room  
____Group/partner  work     ____Did  not  complete  task  or  request  
____Lecture:  Note  taking  required   Frequency  (​ circle  one)   ____Delayed  completion  of  work  
____Lecture:    Listening  only   1-­‐2          3-­‐4            5-­‐6            7-­‐8            9+   ____Provided  w/an  alternate  activity  
____Independent  work     ____In-­‐school  suspension  
____Test/quiz  
Intensity  (​ circle  one)   ____Suspended  from  school  
____Hands  on  activity  
Low        Moderate        High   ____Other:  
____Appeared  bored  
____Demand  made  of  student  
  ____Other:  
____Other:      
____Other:     Attention  Related  Consequences  
Environmental     ____Teacher  redirect  1-­‐  3  times  
____Transition  at  begin/end  of  class   Behavior  2​:   ____Teacher  redirect  4+  times  
____Transition  between  activities     ____Teacher  reprimand  1-­‐3  times  
____Very  structured  activity/setting     ____Teacher  reprimand  4+  times  
____Unstructured  activity/setting     ____Asst.  provided  to  complete  work  
____Change  in  schedule  or  routine   Frequency  (​ circle  one)   ____One-­‐to-­‐one  conf.  w/  teacher  
____Desired  activity  interrupted   1-­‐2          3-­‐4            5-­‐6            7-­‐8            9+   ____Peers  laughed  
____Denied  access  to  a  desired  activity     ____Peers  scolded/jeered  
____Other:   Intensity  (​ circle  one)   ____Letter  to  parents  
____Other:   Low        Moderate        High   ____Phone  call  to  parents  
Interpersonal/Affective     ____Other:  
____No  one  interacting  w/  student     ____Other:  
____Teacher’s  focus  directed  elsewhere    
 
____Received  adult  or  peer  criticism     Access  to  Tangibles/Events  
____Peers  picking  on  student  
  ____Obtained  desired  activity/item  
____Recent  conflict  w/adult  or  peer  
Behavior  3​:   ____Obtained  personal  space  
____Cursing/inapprop.  language  
____Teacher  praise  
  ____Other:  
____Other:     ____Other:  
____Other:      
Cognitive   Frequency   ​ (circle  one)   Punitive  Consequences  
____Task  directions  given   1-­‐2          3-­‐4            5-­‐6            7-­‐8            9+   ____Given  discipline  referral  
____Multi-­‐step  task/direction     ____Loss  of  points/privilege  
____Could  not  locate  materials   Intensity   ​ (circle  one)   ____Other:  
____Confused  by  directions  given   Low        Moderate        High   ____Other:  
____Other:    
____Other:    
Adapted  from  Lohrmann-­‐O’Rourke  (2000)