This behavior reflection form was created to compliment my Classroom Management 123 system (See product). However, it can be used independently, too.
I really like it's effectiveness. There's a self reflection piece to it, which is very important. There is also a parent signature required. It works well because it allows the parents to continue the conversation with their child at home, supporting your efforts in the classroom.
Depending on how you use the number system, determines when you'd use this form. For example, on the system, you can use "1" as a warning - "2' as take a break (student goes to your take a break chair/area to reset and returns to the learning environment when ready or upon your invitation) - and "3" to fill out the reflection form. After students reflect and fill out the form, you would find time to meet with them to decide on the best strategies to help them to self regulate future behaviors.
I use the numbers a bit differently. When students receive a "1", they go to my take a break chair. If behavior persists, I issue a "2" and have students fill out the form. Afterwards, we brainstorm self regulation strategies. I reserve "3"s for office visits or to address behaviors that break overall school rules. This doesn't work for everyone, since all schools have different policies about sending students to the office.
I hope you enjoy using this form. It's worked wonderfully for me!