APPENDIX A

SIBS AND SEBS COMBINED MEASURE

Student Behavior Screening – Teacher Report

Student ID : Gender : MALE or FEMALE (circle one)

Teacher : Grade :
Date :

Directions: For each item, please circle the response that best describes the student’s behavior at school.

Never Occasionally Sometimes Frequently

1. Defiant or oppositional to adults. 0 1 2 3
2. Fights or argues with peers. 0 1 2 3
3. Bullies others. 0 1 2 3
4. Gets angry easily. 0 1 2 3
5. Lies to get out of trouble. 0 1 2 3
6. Disrupts class activities. 0 1 2 3
7. Has difficulty sitting still. 0 1 2 3
8. Nervous, worried, or fearful. 0 1 2 3
9. Bullied by peers. 0 1 2 3
10. Spends time alone. 0 1 2 3
11. Clings to adults. 0 1 2 3
12. Withdrawn. 0 1 2 3
13. Seems sad or unhappy. 0 1 2 3
14. Complains about being sick or hurt. 0 1 2 3
Total Score

Recomendation :
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Bekasi, 02 September 2022

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Range ; 0 – 3 = Indicates Low Risk4 – 8 = Indicates Moderate Risk 9 – 21 = Indicates High Risk