Functional Behavioral Assessment (Fba)
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1
2School Board of Broward County, Florida
FUNCTIONAL BEHAVIORAL ASSESSMENT (FBA)
Last Name:
__________________________
First Name:
________________
Today’s Date:
_________________
DOB:
_____________________________
Grade:
___________________
Student ID#:
_________________
School:
_____________________________
Dates Reviewed:
____________ ____________ ___________ _________
Exceptionalities:____
________ _________
In Attendance:
Name
Title
___________________________________________________
______________________________________________
___________________________________________________
______________________________________________
___________________________________________________
______________________________________________
___________________________________________________
______________________________________________
___________________________________________________
______________________________________________
___________________________________________________
______________________________________________
___________________________________________________
______________________________________________
Rationale
The student is engaging in behavior that places them or others at risk of harm and/or results in substantial property damage.
Behavioral concerns may result in exclusion from participation in activities or settings with peers.
The educational team is considering a more restrictive placement due to behavioral concerns.
The student’s behavioral difficulties persist despite consistently implemented behavior management strategies based on
a less comprehensive or systematic assessment
Other:
____________________________________________________________________________________________
Student Profile
A.
Describe the student’s strengths, skills and interests:
B.
Describe the student’s limitations:
Target Behavior
What is the specific behavior identified for increase or decrease?
Description of behavior (What does the student say or do?)
Baseline Estimate (how often, how long)
Records What records were reviewed?
curriculum/IEP
disciplinary records
previous interventions
anecdotals/home notes
psychological evaluation
other:
What relevant information was obtained?
Conducted by:
__________________________________________________
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