Behavioral Functional Assessment Checklist for Teachers ...



Student: ___________________________ Teacher: _______________________________

Behavioral Functional Assessment Checklist for Teachers & Staff (FACTS)

Student Profile: Please use the space below to identify the student’s strengths. Some possible strengths include academic interests, social skills, hobbies, sports, etc.___________________________________________________________________

_____________________________________________________________________________________________________

Directions: To gain a better understanding of the nature and scope of the problem behavior(s) please check the most relevant item(s). Then provide a brief description of the problem behavior(s), predictors, and consequences.

Antecedent(s): What triggers the problem behaviors and what environmental factors make them more likely to occur:

|Antecedents/Predictors |Environmental Factors |

|Expectations |Need for support |Setting |Internal/External Events |

|Teacher Request |Little structure |Playground |Health factors |

|Difficult Task |Alone (no attention) |Independent work |Tired |

|Confrontation |Independent work |Teacher directed lesson |Hungry |

|Attention from peer(s) |Lack of structure |Group Activity |Medication |

| |Lack of supervision | |Lack of movement |

|Change | |Person |Lack of attention |

|Transitions | |Staff |Earlier conflict |

|Change in routine | |Peer | |

|CONSIDERATIONS: A specific activity that is difficult for student? Does behavior occur alone or with peer group? __________ |

|______________________________________________________________________________________________________ |

Behavior(s): Behavior(s) of concern that are unsafe or disruptive to learning.

|SAFETY |RESPECT |RESPONSIBILITY |

|CONSIDERATIONS: What behavior typically occurs first and how does it escalate? What does behavior look like? |

|_______________________________________________________________________________________________________ |

Consequence(s): What does student appear to achieve from the behaviors:

|Obtain |Escape or Avoid |Current Strategies |

|Control/Power |Difficult Activity/Work | |

|Peer Attention |Adult Attention | |

|Adult Attention |Peer Attention | |

|Activity |Sensory Stimulation | |

|Sensory Stimulation | | |

|Tangible Object | | |

|CONSIDERATIONS: What strategies have been effective: After an incident what does the student obtain (e.g., attention) or avoid (e.g., difficult |

|task)?_________________________________________________________________________________ |

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