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Student name:_________________________________________

Level 1/2 behaviors

bathroom misbehave
cafeteria misbehavior
class misbehavior
disrespectful
hallway misbehavior
inappropriate lang.
no homework
not following dir.
not in line
not paying attention
not prepared
not using time wisely
out of seat
recess misbehavior
spec.class misbehave
talking
1st offence of bullying
other:
Level 3 behaviors
bullying
assault of student
abuse of student
leaving room/area
continuum of level 1
other:
Level 4 behaviors
controlled substance
weapon
fighting
stealing
vandalism
other:

Consequence Level
Consequence
A. Recess ____minutes
B. Planner-Note/Call
C. Information Report
D. Discipline Form
E. Other

Month:___________________________

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