Tier 3 Individual Behavior Intervention Plan Page 5
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5Tier 3 Implementation of PBIP:
When will the PBIP be started? Date: _______________________
Who will implement the PBIP intervention? Name: _____________________________Position: ______________________
Frequency:
When will PBIP interventions be implemented?
______________(1-999) times a /an:
Location:
Where will PBIP interventions be implemented?
Bus / bus area
Cafeteria
Classroom
Hallway
Restroom
Duration: How long will intervention be implemented?
From Date: ______________________________
End Date: _________________________________
Materials:
What materials are needed to implement the PBIP?
What tool will be used to document implementation/outcome?
Frequency chart
Duration chart
Latency chart
ODR analysis and chart
Who will teach student? Name:
Position:
When? (Enter by date)
Follow up:
Who will contact student’s home? Name:
Position:
When will the CPS Team reconvene to discuss?
Date:
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Parent category: Life