Daly, Functional Academic Intervention – Classroom Observation Form
Student:
Date:
Time:
Observer:
School/Gen Ed Teacher:
Academic Engagement (AE): Record student behavior at 20 second intervals using momentary time sampling; includes reading aloud, answering an academic question, asking an
academic question, writing in response to teacher request, and silent reading (eye movements indicate student is scanning text).
Problem Behavior (P): Record student problem behavior (if necessary) using partial interval recording. Definition of problem behavior:
Every two minutes observe the behaviors of a peer.
PB
AE
PB
AE
PB
1-19
20
21-39
40
41-59
Target
0
0
0
0
0
Peer
1-19
20
21-39
40
41-59
Target
0
0
0
0
0
Peer
1-19
20
21-39
40
41-59
Target
0
0
0
0
0
Peer
1-19
20
21-39
40
41-59
Target
0
0
0
0
0
Peer
1-19
20
21-39
40
41-59
Target
0
0
0
0
0
Peer
1-19
20
21-39
40
41-59
Target
0
0
0
0
0
Peer
1-19
20
21-39
40
41-59
Target
0
0
0
0
0
Peer
AE
1
0
3
0
5
0
7
0
9
0
11
0
13
0
PB
1-19
0
1-19
0
1-19
0
1-19
0
1-19
0
1-19
0
1-19
0
Recording method: l - yes, behavior observed; 0 – no, behavior not observed
Tally 1’s for totals in rows for target/peer. Find %’s.
Target Student:
Minutes of Observation X 2.5= 35 Observation Intervals for Target
Sum of AE Column/Observation intervals =
Sum of PB Column/Observation intervals =
% AE
% PB
AE
20
0
20
0
20
0
20
0
20
0
20
0
20
0
PB
21-39
0
21-39
0
21-39
0
21-39
0
21-39
0
21-39
0
21-39
0
AE
40
0
40
0
40
0
40
0
40
0
40
0
40
0
PB
41-59
AE
2
0
41-59
0
4
Total for row
Target
Peer
AE PB
AE PB
0 0
0
0
0
0
41-59
0
6
0
41-59
0
8
0
41-59
0
10
0
41-59
0
12
0
41-59
0
14
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Sum of each ‘Total Column =
Sum of AE Column/Observation intervals =
Sum of PB Column/Observation intervals =
0
0
Peer Student:
Minutes of Observation/2 = 7 Observation Intervals for Target
/35
/35
0
% AE /7
% PB /7