Discipline / Behavioral Incident Tracking Sheet

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Discipline / Behavioral Incident Tracking Sheet
(please include dates and other specific information related to each activity/incident)
--- For each specific individual behavioral incident ---
--- Related to this overall school year ---
**Number of
**Total
**Does the IEP
**Has a functional
days child
days of
**Has a
include a Positive
behavioral
Date
Brief Description of Incident
Outcome *
was removed
removal
FBA been
Behavioral
assessment (FBA)
(include ½
during this
conducted
Intervention (PBI)
been requested?
days)
school year
plan
* Outcomes may include: warning to child; parent asked to pick up child from school early [note time of day child was picked up]; removed from
class to principal’s/other administrator’s office; removal to “time-out” or seclusion room; after-school detention; Saturday detention; in-school
suspension; out-of-school suspension; “easement day”; restraint of child; expulsion; other. Also, please note if the child was removed from his/her
general or special education classroom, did he/she continue to receive all special education and related services in the alternative environment
(including interaction with typical peers if that are included in the child’s IEP)?
**Notes:
A parent or other IEP team member may request reevaluations, including a FBA whenever the child’s academic, social/emotional or behavioral
needs indicate one is necessary to provide the IEP team with information to develop or revise the child’s IEP
If a child has been removed for more than 10 days in a school year, he/she is entitled to receive special education services in his/her interim
alternative educational setting (may be the child’s home or alternative setting) during any days of removal beyond 10 days in a school year.
If one has not yet been conducted, a FBA and PBI plan should be developed by the IEP Team.
If a child has been removed for 10 days at one time, or for a pattern of short-term removals totaling 10 or more days in a school year, the IEP
team must conduct a manifestation determination meeting.
This document is provided for informational purposes only; it does not, nor is it intended to, constitute legal advice. For more information on the special education
process, and upcoming workshop opportunities, please visit our website at
. Be sure to read our brochure, “Steps in the NH Special
Education Process”.

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