Functional Behavioral Assessment Teacher Interview Form
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1
2Functional Behavioral Assessment
Teacher Interview Form
Interviewer(s)_____________________________________________ Date(s)_________________________________
Student(s)_________________________________________________________________________________________
Respondent(s)_____________________________________________ Title___________________________________
1. Describe the behavior of
concern.___________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
2. How often does the behavior occur?________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
How long does it last?____________________________________________________________________________
__________________________________________________________________________________________________
How intense is the behavior?______________________________________________________________________
__________________________________________________________________________________________________
3. What is happening when the behavior occurs?_______________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
4. When/where is the behavior most/least likely to occur?________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
5. With whom is the behavior most/least likely to occur?________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
6. What conditions are most likely to precipitate (“set off ”) the behavior?_________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
7. How can you tell the behavior is about to start?______________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
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