Transcript Module 7: Office Discipline Referral Forms

Module 7: Office Discipline
Referral Forms &
Classroom Behavior
Tracking Forms
Office Discipline Referral (ODR)
Forms
• In formatting the referral form, you must make sure to
answer the following questions:
Who
What
Where
Why
When
• Clarity on the referral form takes the guess work out of
the data entry person’s job
• Data will be more reliable and accurate as
judgement calls are minimized
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Compatible Referral Form
The following categories must be included on
the form:
•Student’s Name
•Date
•Time of Incident
•Student’s Teacher (optional)
•Student’s 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
Characteristics of a SWIS III
Compatible Referral Form
•
•
•
•
Student’s Name
Date
Time of Incident
Student’s Teacher
(optional)
• Student’s 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
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Developing the ODR
Challenges:
Solutions:
•
•
•
County required form
The form is not filled
out correctly
•
Create a
supplemental form
with additional
information
Re-train faculty or
return to faculty to fill
out completely before
processing
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Module 7: Office
Discipline Referral Forms
and Classroom Behavior
Tracking Forms.
Minor Infraction Report
Student Name (Last, First, Middle Initial)
HR Teacher
Grade
Race Date
Incident Location: (Circle One)
1. Bathroom/Restroom
9. Library
2 Bus Ramp
10. Office
3. Cafeteria
11. Bus #___
4. Classroom
12. Other
5. Commons/Common Area
13. Playground
6. Gymnasium
Incident Type: (Circle One)
1. Dress Code
6. Harassment/Tease/Bully
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_______
Contract
2. Re-teach Expectation
7. Peer Mediation______
Other__________
3. Seating Change
8. Parent Conference______
4. Letter to Parent______
9. Curricular Modification
Time
Referring Teacher
Possible Motivation: (Circle One)
1. Avoid Adult
5. Obtain Adult Attention
2. Avoid Peers
6. Obtain Items/Activities
3. Avoid Task/Activities 7. Obtain Peer Attention
4. Don’t Know
8. Other
Expectation Violated: (Circle One)
Respectful Responsible Ready to Learn
Incident Description:_________________________
____________________________________________
_____________________________________________
10. Time Out
14. Student
11. Loss of Class Privilege
15.
12. Refer to Guidance
13. Sent to Rm. #__________
(Please sign and return to school)
Parent Signature_______________________________
Parent
Comments__________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
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)
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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)
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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)
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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?
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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?
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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.
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