1. DISTRICT SCHOOL BOARD OF PASCO COUNTY
BEHAVIOR OBSERVATION FORM (Completed by Person Other than Classroom Teacher) REV. 09/2007
DIRECTIONS: Observe the behavior of the target student OR the comparison peer (P) for a 45-second interval then record the behaviors for the next 15 seconds. During the 15 seconds, place one check mark (√) next to each category of
behavior that occurred during the 45-second interval and place two check marks (√√) next to the behaviors that occurred frequently. Write comments as appropriate. Each column will equal 1 minute of the observation.
1
Student: Date: Name & Title of Observer:
Teacher: Starting Time: Ending Time: Purpose of Observation:
A. Subject /Lesson Observed: _____ Other:__________________ B. Learning Activity/Situation: _____ Other:__________________
_____ Language Arts _____ Social Studies _____ Large Group Instruction _____ Small Group Instruction
_____ Mathematics _____ Science _____ Cooperative Group _____ Independent Work
_____ P.E. _____ Art _____ Music _____ Structured _____ Unstructured Activity
Target Student Target Student Target Student Target Student
STUDENT & PEER (P) P 1’ 2’ 3’ 4’ 5’ P 6’ 7’ 8’ 9’ 10’ P 11’ 12’ 13’ 14’ 15’ P 16’ 17’ 18’ 19’ 20’ P Total COMMENTS
On-Task/Attentive
Off-Task Motor
Off-Task Noise
Off-Task Passive
Out–of--Seat
Out-of-Area
Disruption
Negative Comment
Calling Out
Talking
Teasing
Physical Aggression
Property Destruction
Other:
Other:
Other:
TEACHER P 1’ 2’ 3’ 4’ 5’ P 6’ 7’ 8’ 9’ 10’ P 11’ 12’ 13’ 14’ 15’ P 16’ 17’ 18’ 19’ 20’ P Total COMMENTS
Not Attending
Attending
Planned Ignoring
Redirecting
Rewarding
Giving Consequences
Other:

2. 2
C. General Observations Regarding Student’s Behavior (Check twice (√√) if a behavior occurred frequently):
_____ Initiates assignments _____ Refuses to participate _____ Seems easily distracted _____ Perseverates (repeats)
_____ Displays interest _____ Requires prompting to do work _____ Asks to leave class _____ Sinks down in chair
_____ Transitions well _____ Plays with clothing or objects _____ Follows class rules and routines _____ Is friendly to peers
_____ Seems attentive _____ Has difficulty copying _____ Shows initiative & self-direction _____ Demands excessive attention
_____ Talks out of turn _____ Careless, doesn’t pay attention _____ Is reminded of class rules _____ Uses appropriate tone of voice
_____ Overactive, restless _____ Constantly out of seat behavior _____ Talks excessively _____ Contributes to class
_____ Bothers others _____ Tries to control others _____ Is shy or timid _____ Seems tired or drowsy
_____ Works well independently _____ Clings to teacher or others _____ Displays self confidence _____ Behaviors are reprimanded
_____ Daydreams _____ Has trouble finding place _____ Easily frustrated _____ Disorganized work habits
_____ Aggressive toward children _____ Speaks clearly _____ Avoids groups _____ Is disruptive
_____ Avoids eye contact _____ Uses obscene language _____ Is cooperative _____ Laughs/sings inappropriately
_____ Makes bizarre statements _____ Makes distracting noises _____ Does not finish what is started _____ Other:
D. Additional Comments/Observations:
E. Follow-Up: Date: ________/__________/__________ Times that teacher can meet: Before School After School Other: ________________