School Wide Behavior Plan Infraction Log Sheet: Level 1 Behavior Infractions Chart #1 Student’s Name: _________________ Guardian’s Name & No.___________________________ Plan of Action: date: ______________ Teacher Initials____ Student Initials_____ STEP #1 CONSEQUENCE DATE INF #1 Quarter___ Written Ref. date: ______________ Completed & signed Y N INF #2 Quarter___ Written Ref. date: ______________ Completed & signed Y N INF #3 Quarter___ Written Ref. date: ______________ Completed & signed Y N INF #4 Quarter___ Written Ref. date: ______________ Completed & signed Y N TEACHER/PARENT CONTACT: PERSON CONTACTED______________PHONE #_______________ DATE________ TIME_____CIRCLE ONE CONFERENCE PHONE CALL EMAIL Behavior Goal Sheet filled out: date: ______________ Teacher Initials____ Student Initials_____ Revisit Plan of Action: date: ______________ Teacher Initials____ Student Initials_____ STEP #2 CONSEQUENCE DATE INF #5 Quarter___ REC CENTER DUTY: ______________ DATE_________ T/AOD Initials _______ INF #6 Quarter___ REC CENTER DUTY: ______________ DATE_________ T/AOD Initials _______ INF #7 Quarter___ REC CENTER DUTY: ______________ DATE_________ T/AOD Initials _______ TEACHER/PARENT CONTACT: PERSON CONTACTED______________PHONE #_______________ DATE________ TIME_____CIRCLE ONE CONFERENCE PHONE CALL EMAIL Revisit Plan of Action + Behavior Goal Sheet: date: ______________ Teacher Initials____ Student Initials_____ *AT STEP #3 STUDENT WILL NOT BE ABLE TO PARTICIPATE IN SCHOOL EXTRA-CURRICULAR ACTIVITIES, OUTDOOR ACTIVITIES, FIELD TRIPS, ETC. FOR A WEEK FOLLOWING THE INFRACTION. STEP #3 CONSEQUENCE DATE INF #8 Quarter___ REC CENTER DUTY + Written Ref.: ______________ DATE_________ T/AOD Initials _______ INF #9 Quarter___ REC CENTER DUTY + Written Ref.: ______________ DATE_________ T/AOD Initials _______ INF #10 Quarter___ CIRCLE ONE CONFERENCE PHONE CALL EMAIL ADMIN/PARENT CONTACT: PERSON CONTACTED______________PHONE#______________________ DATE______ TIME_____ SUSPENSION DATE________ RETURN DATE________T/AOD Initials _______ School Wide Behavior Plan Infraction Log Sheet: Level 1 Behavior Infractions Chart #2 Student’s Name: _________________ Guardian’s Name & No.___________________________ Plan of Action: date: ______________ Teacher Initials____ Student Initials_____ STEP #4 CONSEQUENCE DATE INF #11 Quarter___ Written Ref. date: ______________ Completed & signed Y N INF #12 Quarter___ Written Ref. date: ______________ Completed & signed Y N INF #13 Quarter___ Written Ref. date: ______________ Completed & signed Y N TEACHER/PARENT CONTACT: PERSON CONTACTED______________PHONE #_______________ DATE________ TIME_____CIRCLE ONE CONFERENCE PHONE CALL EMAIL Behavior Goal Sheet filled out: date: ______________ Teacher Initials____ Student Initials_____ Revisit Plan of Action: date: ______________ Teacher Initials____ Student Initials_____ STEP #5 CONSEQUENCE DATE INF #14 Quarter___ REC CENTER DUTY: ______________ DATE_________ T/AOD Initials______ INF #15 Quarter___ REC CENTER DUTY: ______________ DATE_________ T/AOD Initials______ INF #16 Quarter___ REC CENTER DUTY: ______________ DATE_________ T/AOD Initials______ INF #17 Quarter___ REC CENTER DUTY: ______________ DATE_________ T/AOD Initials______ TEACHER/PARENT CONTACT: PERSON CONTACTED______________PHONE #_______________ DATE________ TIME_____CIRCLE ONE CONFERENCE PHONE CALL EMAIL Revisit Plan of Action + Behavior Goal Sheet: date: ______________ Teacher Initials____ Student Initials_____ *AT STEP #6 STUDENT WILL NOT BE ABLE TO PARTICIPATE IN SCHOOL EXTRA-CURRICULAR ACTIVITIES, OUTDOOR ACTIVITIES, FIELD TRIPS, ETC. FOR A WEEK FOLLOWING THE INFRACTION. STEP #6 CONSEQUENCE DATE INF #18 Quarter___ REC CENTER DUTY + Written Ref.: ______________ DATE_________ T/AOD Initials _______ INF #19 Quarter___ REC CENTER DUTY + Written Ref.: ______________ DATE_________ T/AOD Initials _______ INF #20 Quarter___ CIRCLE ONE CONFERENCE PHONE CALL EMAIL ADMIN/PARENT CONTACT: PERSON CONTACTED______________PHONE#______________________ DATE______ TIME_____ SUSPENSION DATE________ RETURN DATE________T/AOD Initials _______