Behavior Check-In/Check-Out Tracking Form
Record and monitor behavior at the beginning and end of each session.
Name of Individual
*
First Name
Last Name
Date of Session
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location or Setting
*
Observer Name
*
First Name
Last Name
Check-In Time
*
Hour Minutes
AM
PM
AM/PM Option
Check-Out Time
*
Hour Minutes
AM
PM
AM/PM Option
Behavior Goals or Focus Areas (select all that apply)
*
On-task behavior
Respectful interactions
Following instructions
Emotional regulation
Other
Check-In Behavior Rating
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Check-Out Behavior Rating
*
Needs Improvement
1
2
3
4
Excellent
5
1 is Needs Improvement, 5 is Excellent
Comments or Notes (Check-In)
Comments or Notes (Check-Out)
Next Steps or Action Plan
Submit
Should be Empty: