Behavior Intervention Check-In/Check-Out Tracker
Track daily student behavior, interventions, and progress during behavioral support programs.
Student Name
*
First Name
Last Name
Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Staff Member Completing Form
*
First Name
Last Name
Check-In Time
*
Hour Minutes
AM
PM
AM/PM Option
Check-Out Time
*
Hour Minutes
AM
PM
AM/PM Option
Behavioral Targets Progress
*
Rows
Not Met
Partially Met
Met
Followed Directions
1
2
3
Stayed on Task
4
5
6
Used Appropriate Language
7
8
9
Managed Emotions
10
11
12
Interventions Used Today
Verbal Prompt
Positive Reinforcement
Break Provided
Visual Reminder
Other
Specific Behaviors Observed
On-Task
Disruptive
Respectful
Aggressive
Other
Overall Daily Behavior Rating
*
1
2
3
4
5
Comments and Observations
Follow-Up Actions or Recommendations
Parent/Guardian Contacted?
Yes
No
Submit Check-In/Check-Out
Should be Empty: