2. Module 7: Office Discipline Referral Forms & Classroom Behavior Tracking Forms

3. 2 Office Discipline Referral (ODR) Forms In formatting the referral form, you must make sure to answer the following questions: WhoWhy WhatWhen Where Clarity on the referral form takes the guess work out of the data entry persons job Data will be more reliable and accurate as judgement calls are minimized

4. Characteristics of a SWIS III Compatible Referral Form The following categories must be included on the form: Students Name Date Time of Incident Students Teacher (optional) Students Grade Level Referring Staff Location of Incident Problem Behavior Possible Motivation Others Involved Administrative Decision * Other Comments No more than 3 extra info. * Will be discussed in a future module

5. 4 Characteristics of a SWIS III Compatible Referral Form Students Name Date Time of Incident Students Teacher (optional) Students Grade Level Referring Staff Location of Incident Problem Behavior Possible Motivation Others Involved Administrative Decision * Other Comments No more than 3 extra info. * Will be discussed in a future module

6. 5 Developing the ODR Challenges: County required form The form is not filled out correctly Solutions: Create a supplemental form with additional information Re-train faculty or return to faculty to fill out completely before processing

7. Module 7: Office Discipline Referral Forms and Classroom Behavior Tracking Forms.

8. Minor Infraction Report Student Name (Last, First, Middle Initial) Grade RaceDateTimeReferring Teacher HR Teacher Incident Location: (Circle One)Possible Motivation: (Circle One) 1. Bathroom/Restroom 9. Library1. Avoid Adult5. Obtain Adult Attention 2 Bus Ramp 10. Office2. Avoid Peers6. Obtain Items/Activities 3. Cafeteria 11. Bus #___3. Avoid Task/Activities 7. Obtain Peer Attention 4. Classroom 12. Other4. Dont Know8. Other 5. Commons/Common Area 13. Playground Expectation Violated: (Circle One) 6. GymnasiumRespectfulResponsibleReady to Learn Incident Type: (Circle One) 1. Dress Code 6. Harassment/Tease/Bully Incident Description: _________________________ 2. Inappropriate Lang. 7. Property Damage 3. Disruption 8. Forgery/Theft ____________________________________________ 4. Defiance/Disrespect 9. Chewing Gum 5. Lying/Cheating 10. Other _________________________________________________________ Intervention: (All that Apply) 1. Student Conference______ 6. Phone Parent_______ 10. Time Out14. Student Contract 2. Re-teach Expectation 7. Peer Mediation______11. Loss of Class Privilege15. Other__________ 3. Seating Change 8. Parent Conference______12. Refer to Guidance 4. Letter to Parent______ 9. Curricular Modification13. Sent to Rm. #__________ (Please sign and return to school) Parent Signature _______________________________ Parent Comments __________________________________________________________________________________________________ _________________________________________________________________________________________________________________

9. 8 Goal of the Tracking Form Collect data that are necessary to identify effective ways of changing inappropriate classroom behavior ( minor ) before it results in an office discipline referral ( major )

10. 9 Classroom Tracking Forms Classroom behaviors take up considerable amounts of teacher time that could be better spent on instruction Forms assist in identifying the pattern of behavior and determining interventions that will be most effective for the student(s)

11. 10 Guidelines When does a recurring behavior become a major? Same behavior (3 minors = 1 major) From one particular teacher Suggested time frame ( 3minors within 4 weeks) Used as a tool to identify patterns of behavior When are the behaviors occurring? (math, transition) What are the recurring behaviors? What are the classroom interventions that have been used? Are these interventions working or does something else need to be utilized? Why is the behavior occurring? (motivation, example: Johnny rips up his math sheet and is given time out and gets out of his work. He always gets to avoid doing his math work)

12. 11 Reflection Questions Answer these questions about your SW-PBS team: 1.Does your referral form have the following. "Yes" or "No" for each part. a. Student's Name? b. Student's Ethnicity? c. Grade Level? d. Date? e. Time? f. Referring Staff? g.Incident Type? h. Location? i. Motivation? j. Others Involved? k. Administrative Decision?

13. 12 Reflection Questions Answer these questions about your SW-PBS team: 2. Does the staff at your school consistently fill out the form correctly? If no, provide some suggestions for ways to retrain the staff. 3. Does your school use a minor or classroom behavior tracking form? 4. If you answered "Yes" to question 3: -are staff consistently using the form? -are staff correctly using the form? If you answered "No" to either part of 4a. What are some suggestions for retraining your staff on using the minor form?

14. 13 Congratulations! You have completed Florida's PBS Project School-wide Positive Behavior Support Module 7: Office Discipline Referral Forms and Classroom Behavior Tracking Forms. If you would like a certificate of completion please print this page.