Behaviour Incident Form

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Behaviour Incident Form

Child’s Name_________________________________________________________Date of incident _________Time____

Describe Incident

____________________________________________________________________________________________

What was happening in the room and with the child immediately before the incident?

____________________________________________________________________________________________

What do you think the child was trying to say?

____________________________________________________________________________________________

___________________________________________________________________________________________

What strategies did educators implement to manage the incident (or how did they react)?

_____________________________________________________________________________________________

____________________________________________________________________________________________

Describe any strategies that worked.

____________________________________________________________________________________________

Have you spoken with parents about the behaviour? Yes No

The Plan

If yes, what was the outcome of this conversation?

____________________________________________________________________________________________

What strategies can you try if the behaviour occurs again? (These may differ to the strategies used).

____________________________________________________________________________________________

______________________________ _____________________________

Educator’s Name Educator’s Signature

______________________________

Date

If there have been repeated incidents Room Leader or Nominated Supervisor may need to develop a behaviour management plan with families and/or suggest families seek outside professional support for an undiagnosed condition where relevant.

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