Jackson County School Board ::

Contact Roberta Griffith, EBD Program Specialist

if you have any questions about the use of any of these forms.

^{482-1310, ext 226}


FBA Documents	(10 Files)
ABC Recording Form
Analyzing Patterns
Duration Data Sheet (Worksheet)
Event Frequency Data Sheet (Worksheet)
Functional Behavior Rating Tool
Interview Guide for Functional Assessment
Manual Physical Restraints (Excel Document)
Record Review Form
Scatter Plot
Time Sampling Record Sheet (Worksheet)
FBA Forms	(7 Files)
JC-048 Functional Behavior Assessment
JC-163 Behavior Intervention Plan
JC-438 Request For Parent Input For Functional Behavior Assessment
JC-513 Manual Physical Restraint Documentation and Debriefing
JC-542 Written Notification of the Use of Manual Physical Restraint or Seclusion
JC-547 Behavior Analysis Services Referral
Restraint Documentation Log
Behavioral Intervention According to Function	(10 Files)
If the function is to Escape �Sensory Overload�
Interventions for the Function of Non-Social/Internal Stimulation
Interventions for the Function of Revenge/Justice
Interventions if the Function is Power/Control
Peer Attention or Social Status
Possible Interventions for the Function of Attention
Possible Interventions for the Function of Escape/Avoidance/Delay
Possible Interventions if the Function is to Escape from Adults
Possible Interventions if the Function is to Gain Access to Tangibles/Preferred Activities
Possible Interventions If the Student Wants to Escape from Peers

"Jackson County Public Schools...Our Future"