Functional Behavior Assessment & Intervention Plan
Complete this form to document behavioral assessment findings and develop an effective intervention plan.
Individual's Full Name
*
First Name
Last Name
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor's Name
*
First Name
Last Name
Describe the Target Behavior(s)
*
Behavioral Observation: ABC (Antecedent-Behavior-Consequence) Data
*
Rows
Antecedent
Behavior
Consequence
Observation 1
Observation 2
Observation 3
Frequency or Intensity of Behavior
*
Rarely
1
2
3
4
Very Often
5
1 is Rarely, 5 is Very Often
Hypothesized Function of Behavior
*
Attention-seeking
Access to Tangibles
Escape/Avoidance
Sensory Stimulation
Other
Intervention Strategies to be Implemented
*
Teach replacement behaviors
Modify environment/antecedents
Positive reinforcement
Planned ignoring
Crisis intervention plan
Other
Progress Monitoring Method
*
Please Select
Daily Data Collection
Weekly Review
Graphing Behavior Trends
Staff Feedback
Other
Team Members Involved in Plan
Date for Plan Review
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional Notes or Comments
Submit Plan
Should be Empty: