Functional Behavioral Assessment (Page 4 of 4) in pdf

Functional Behavioral Assessment Page 4

FBA (Page

of 4)

Evaluation Date of BIP:

Evaluation of Behavior Intervention Plan

Describe student’s progress toward the replacement behavior(s):

Were the steps in the BIP implemented as indicated (be specific):

Describe any modifications, deletions, or revision that the committee feels would enhance the effectiveness of

the plan based on new information gained since the initial BIP:

Revised BIP

Replacement Behavior

Activities/Modifications

Reinforcements

Consequences

How many days will BIP be in effect before evaluated:

Date of next meeting for revised BIP:

At the next meeting, the IEP Team may choose to continue to use the BIP (including any revisions), revise the BIP

again or start the process over (new functional behavioral assessment and BIP) based on new information.

Use Continuation FBA (Page 4 of 4)

Signatures of IEP Team members who attended this meeting on:

LEA Representative:

Special Ed Teacher:

Regular Ed Teacher:

School Psychologist:

Parent/Guardian:

Student (If appropriate):

Other:

Functional Behavioral Assessment Page 4