Name ________________ Week 1 Monday Month ___________ Tuesday Wednesday Thursday Friday Thursday Friday Behavior Code Parent’s Initials Behavior Codes: 1. Not listening 6. Not following directions 2. Not doing my work. 7. Hurt a friend on the inside 3. Talking out of turn. 8. Hurt a friend on the outside 4. Being disrespectful 9. Difficulty with self- control 5. Out of my seat 10. Not participating 16. Other: __________________________ 11. Misbehaved at lunch 12. Misbehaved at recess 13. Misbehaved at specials 14. Misbehaved in bathroom 15. Misbehaved in hallway Comments: Week 2 Monday Tuesday Wednesday Behavior Code Parent’s Initials Behavior Codes: 1. Not listening 6. Not following directions 2. Not doing my work. 7. Hurt a friend on the inside 3. Talking out of turn. 8. Hurt a friend on the outside 4. Being disrespectful 9. Difficulty with self- control 5. Out of my seat 10. Not participating 16. Other: __________________________ Comments: 11. Misbehaved at lunch 12. Misbehaved at recess 13. Misbehaved at specials 14. Misbehaved in bathroom 15. Misbehaved in hallway Week 3 Monday Tuesday Wednesday Thursday Friday Thursday Friday Behavior Code Parent’s Initials Behavior Codes: 1. Not listening 6. Not following directions 2. Not doing my work. 7. Hurt a friend on the inside 3. Talking out of turn. 8. Hurt a friend on the outside 4. Being disrespectful 9. Difficulty with self- control 5. Out of my seat 10. Not participating 16. Other: __________________________ 11. Misbehaved at lunch 12. Misbehaved at recess 13. Misbehaved at specials 14. Misbehaved in bathroom 15. Misbehaved in hallway Comments: Week 4 Monday Tuesday Wednesday Behavior Code Parent’s Initials Behavior Codes: 1. Not listening 6. Not following directions 2. Not doing my work. 7. Hurt a friend on the inside 3. Talking out of turn. 8. Hurt a friend on the outside 4. Being disrespectful 9. Difficulty with self- control 5. Out of my seat 10. Not participating 16. Other: __________________________ Comments: 11. Misbehaved at lunch 12. Misbehaved at recess 13. Misbehaved at specials 14. Misbehaved in bathroom 15. Misbehaved in hallway
