SAT/RtI Team Student Name:____________________________
Date: ______________________
FUNCTIONAL BEHAVIOR ASSESSMENT CHECKLIST ____Review of school records AND ____available outside agency professional records ____Systematic, direct observations of student across school settings ____Interviews with the ____student AND ____parent/caregiver AND ____teachers AND ____other appropriate school personnel AND ____appropriate community service providers ____Completion and review of behavior rating scales and/or other assessment tools ____Target behavior is operationally defined in specific, observable, and measureable terms ____Information is collected across respondents AND ____settings ____Collected information allows determination of patterns of ____frequency AND ____duration AND ____intensity ____Antecedent events that serve as a stimulus for the target behavior are identified and described ____Consequences that follow and maintain the target behavior are identified and described ____Function or purpose of the target behavior is identified ____Reinforcers are identified ____Hypothesis is generated about the relationship between the target behavior, antecedents and consequences, AND ____specific variables to be manipulated are identified ____Intervention is developed based upon hypothesis ____Acceptable replacement behaviors are identified ____Alternative skills needed for replacement behavior are identified ____Determination is made whether student has alternative skills in his/her behavior repertoire and if not, which skills must be taught