Tiers Dbr Progress Monitoring Tool Form Page 2
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2TIERS DBR Progress Monitoring Tool
Student:______________________
Teacher:_________________________
Date of rating:_________________ (Complete at the end of each day)
Circle Level:
I
II
III
Cluster 1 On-task Behavior: “e.g., the extent to which the student worked on the task at hand or paid attention
to the lesson being delivered, etc.”
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Cluster 2 Prosocial Behavior: “the extent to which the student engaged in positive conversations, actively
listened, shared, cooperated during academic work and played or interacted with other students.”
Number of times:
0
1
2
3
4
5
6
7
8
9
10
Cluster 3 Disruptive Behavior: “e.g., number of times the student blurts out answers, gets out of seat, makes
distracting noises, interrupts peers’ work, etc. ”
Total Number of times: 0
1
2
3
4
5
6
7
8
9
10
Intensity:
Mild________
Moderate_________
Severe_________
Cluster 4 Negative Social Interactions: “e.g., the number of times the student is defiant or noncompliant to
adult request or warning (do not count slow compliance), teases or calls peers or staff names or swears at them,
takes others’ belongings.”
Number of times:
0
1
2
3
4
5
6
7
8
9
10
Intensity:
Mild________
Moderate_________
Severe_________
Cluster 5 Destructive or Dangerous Behaviors: “the number of times the student attempts or actually assaults
others, destroys property, runs away, attempts or actually harms self.”
Number of times:
0
1
2
3
4
5
6
7
8
9
10
Intensity:
Mild________
Moderate_________
Severe_________
Cluster 6 Individualized Behavior: ____________________________________________________________
Number of times:
0
1
2
3
4
5
6
7
8
9
10
Teacher comments regarding behaviors above:
Student referred to the office for debriefing a problem behavior:
Yes ______
No______
Teacher Signature:________________
Feedback to teacher (describe how you handled your child’s performance today,
e.g., praised child, earned activity, loss
and any home events that may affect tomorrow’s performance
of privilege, extra chore,
):
Parent Signature:_________________
PENT Forum 2014
Section 3 Progress Monitoring
Page 20 of 33
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