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DAILY BEHAVIOUR LOG

Student Name _____________________ Grade ____ Gender M /F School __________________________ School Year _______

D.O.B. ____________ IEP: ___ YES ___ NO Behaviour Support Plan: ___ YES ____ NO ___ NO

Safe Intervention Plan ____ YES

Date

Time

Description/ Antecedent/ Trigger(s)

Location

Behaviour
(use # e.g., 4 biting)

Injury
Y/N S- student A- Adult

Follow-up strategies

Parent/ Guardian Notified

Recorder's Name

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