Functional Behavioral Assessment (Fba) Page 2
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1
2School Board of Broward County, Florida
FUNCTIONAL BEHAVIORAL ASSESSMENT (FBA)
Last Name:
_________________________
First Name:
________________
Today’s Date:
_________________
DOB:
__________________________
Grade:
_________
Student ID#:
_________________
School:
__________________________
Dates Reviewed:
_________ __________ __________ ____________
Indirect Assessments
What interviews were conducted?
student
parent
ESE teacher
general education teacher
school administrator
related services provider
other interviews:
other indirect assessments:
Conducted by:
____________________________________________
Direct Assessments
What data was collected?
Data Collected:
Date(s):
Conducted by:
A-B-C
Scatter plot(s)
Frequency
Duration
Latency
Other:
Other:
What relevant information was obtained:
Setting Events
Are there other variables that appear to be affecting the student’s behavior (e.g., medical problems, curricular
issues?
Summary (Hypothesis) Statements
Patterns
What patterns were identified in the data collected? (i.e., circumstances in which the behavior is most likely/least likely;
possible functions of the behavior)
When this occurs:
the student does
to get, or avoid
(describe the circumstances)
(describe the behavior)
(describe consequences)
Based on the FBA:
Interventions to be implemented:
A Positive Behavioral Intervention Plan (PBIP) will be developed
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