Behavior System — Universal Daily Behavior Check Sheet

For teachers to complete daily and return to case manager.

Student: _____________________________ Date: ____________
Grade: ____________ Case Manager: _____________________
Teacher: __________________________ Class/Period: _____________________

Ratings (circle or check 0, 1, or 2 for each block)

0 = Not yet / many problems    1 = Mixed / some problems    2 = Met goal for this block

Block GOAL 1: Stayed in class / in assigned area GOAL 2: Followed directions / accepted redirection GOAL 3: Used school language / kept hands & feet safe Notes (brief)
012 012 012
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Teacher Summary (end of day)

Circle one and add brief comments.

Overall day:   0 = Very difficult    1 = Mixed    2 = Mostly successful

What went well: ____________________________________________________________

___________________________________________________________________________________________

Needs / concerns: __________________________________________________________

___________________________________________________________________________________________

Teacher signature: ____________________________    Time: __________