ABC Checklist

Student Name:____________________ Teacher: ________________

Date Time Antecedent Behavior Consequence Duration
___Alone ___Refusing to ___Ignored ___< 1 min.
___With peers follow directions ___Used proximity
___Preparing for outing ___Disrupting ___Nonverbal cue ___ 1-5
___Ending an activity class ___Verbal warning min.
___Participating in group ___Making verbal ___Changed
___Asked to do something threats assignment ___ 5-10
___Asked/told “not to” ___Hurting self ___Redirected min.
___Transitioning ___Destroying ___Loss of
___Working on academics property privileges ___ 10-30
___At recess ___Screaming/ ___Gave time out min.
___Being ignored Yelling ___Referral
___At lunch ___Refusal to ___ 1/2 -1
___Given a warning complete work hr.
___About to begin new ___Throwing/
activity Kicking ___ >1 hr.
___Other ___Other

Date Time Antecedent Behavior Consequence Duration

___Alone ___Refusing to ___Ignored ___< 1 min.
___With peers follow directions ___Used proximity
___Preparing for outing ___Disrupting ___Nonverbal cue ___ 1-5
___Ending an activity class ___Verbal warning min.
___Participating in group ___Making verbal ___Changed
___Asked to do something threats assignment ___ 5-10
___Asked/told “not to” ___Hurting self ___Redirected min.
___Transitioning ___Destroying ___Loss of
___Working on academics property privileges ___ 10-30
___At recess ___Screaming/ ___Gave time out min.
___Being ignored Yelling ___Referral
___At lunch ___Refusal to ___ 1/2 -1
___Given a warning complete work hr.
___About to begin new ___Throwing/
activity Kicking ___ >1 hr.
___Other ___Other