Functional Communication Training (FCT) Data Collection Form
Complete this Functional Communication Training (FCT) Data Collection Form to document session details and communication outcomes.
Session Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Staff Name
*
First Name
Last Name
Client Initials
*
Target Communication Response
*
Please Select
Request for break
Request for attention
Request for item/activity
Other
Antecedent(s) Observed
*
Task demand presented
Attention withheld
Preferred item removed
Transition announced
Other
Consequence(s) Delivered
*
Access to break
Access to attention
Access to item/activity
Token/reward given
Other
Prompt Level Used
*
Independent
Verbal prompt
Gestural prompt
Physical prompt
Other
Number of Independent Responses
*
Number of Prompted Responses
*
Session Duration (minutes)
*
Additional Notes or Observations
Submit Session Data
Should be Empty: