Time Sampling Record Sheet
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1Time Sampling Record Sheet
10-minute intervals
1
Student: ___________________________________________________________________ Date: ______________________
Behavior: ______________________________________________________________________________________________
(Circle 1, 2, or 3)
TYPE: 1. Whole Interval
TYPE: 2. Partial Interval
TYPE: 3. Momentary
+ = behavior is continuous
+ = single instance is
+ = record only if
in interval
observed in interval
behavior present at end
Record + or –
of interval
+ or –
Comments*
+ or –
Comments*
+ or –
Comments*
8:00-8:09
11:10-11:19
2:20-2:29
8:10-8:19
11:20-11:29
2:30-2:39
8:20-8:29
11:30-11:39
2:40-2:49
8:30-8:39
11:40-11:49
2:50-2:59
8:40-8:49
11:50-11:59
3:00-3:09
8:50-8:59
12:00-12:09
3:10-3:19
9:00-9:09
12:10-12:19
3:20-3:29
9:10-9:19
12:20-12:29
3:30-3:39
9:20-9:29
12:30-12:39
3:40-3:49
9:30-9:39
12:40-12:49
3:50-3:59
9:40-9:49
12:50-12:59
4:00-4:09
9:50-9:59
1:00-1:09
4:10-4:19
10:00-10:09
1:10-1:19
4:20-4:29
10:10-10:19
1:20-1:29
4:30-4:39
10:20-10:29
1:30-1:39
4:40-4:49
10:30-10:39
1:40-1:49
4:50-4:59
10:40-10:49
1:50-1:59
5:00-5:09
10:50-10:59
2:00-2:09
11:00-11:09
2:10-2:19
*Comments column can be used to describe any prompts or redirections, type of activity, or other variables useful to identify that interval.
From "Incorporating the Use of Non-Aversive Behavior Management," AZ-TAS Themes and Issues, 1992,
1
Arizona Department of Education.
B - 18
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