Functional Behavior Assessment Form

Gather structured observations about a student's conduct, from strengths and problem behaviors to frequency, triggers, and consequences. A clear tool for teachers, counselors, and school support teams.

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Date

Student Name

First Name

Last Name

Student Level/Grade

Homeroom Teacher

First Name

Last Name

Strengths and unique qualities this student brings to the school

Problem Behaviors

Aggression Classroom disruption Defiance Withdrawal Property destruction Self-injury

Please explain more about the problem behavior

How often does this behavior happen?

What is the duration, in terms of when it starts and when it ends?

How big is this problem behavior?

Do you know what triggers the problem behavior? Is it related to tasks, activities, reprimands, or transitions?

Are the following events related to the behavior? Please select one or more:

Hunger Lack of sleep Medication change Conflict at home Routine change Illness

Setting Events

Trigger

Behavior

Consequence

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