Behaviour Incident Report

BEHAVIOUR INCIDENT REPORT

STUDENT DETAILS:

Name:

Year/Grade:

Date of Incident:

Time:

Location:

Reported By:

ANTECEDENT:

[What was happening before the behaviour — context, triggers, setting events]

BEHAVIOUR:

[Factual description of the behaviour observed — what did the student do/say?]

CONSEQUENCE:

[What happened after the behaviour — responses from staff, peers, environment]

SEVERITY:

( ) Minor — managed in classroom

( ) Moderate — required additional support

( ) Major — required removal from setting

( ) Critical — safety risk to self or others

OTHER STUDENTS/STAFF AFFECTED:

[Who else was involved or impacted]

ACTIONS TAKEN:

[Immediate responses and interventions]

PARENT/CARER NOTIFICATION:

( ) Not required

( ) Phone call — Date/Time:

( ) Written notification — Date:

FOLLOW-UP PLAN:

[Ongoing strategies, referrals, support plans]

REPORTING STAFF SIGNATURE:

DATE: