Level 1 Behavior Form
Teacher Passcode
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Student Name
*
First Name
Last Name
Number of Level One
Please Select
1
2
3
4
Date and time of Behavior
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Type of Parent Communication
Phone call
face to face
Other
Date and time of Parent Communication
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Reporting Teacher
First Name
Last Name
Home Room Teacher
First Name
Last Name
Level 1 Behavior Incidents are defined as behavior that are in defiance of school norms. Examples include but are not limited to:
Talking out of turn
Insubordination
Minor misuse of technology
Profanity
Lack of preparedness
Working inappropriately in a group
Misuse of property
Play/Mock fighting
Dress Code Violations
Tardiness
Minor Bullying
Minor theft
cheating/dishonesty
Horesplay
Inappropriate displays of affection
Other
Reason for Behavior Report
Description of Behavior
Interventions Used Prior to Behavior Report
Whole Class reminder of expectations
One on one reminder of expectations
Self Reflection
Pep talk with Recovery
Automatic Level 1
Other
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