I developed this form to use in my classroom as a way for students to reflect on their behavior. Instead of just giving a consequence for a negative behavior without any learning taking place, this form ensures that students are thinking about their behavior and describing it specifically, their motivation for the behavior, and how they can act differently in the future. This teaches students to take responsibility for their actions. This forms also helps guide conferences with the students and the parents as well as serving as a source of communication between teachers and parents. Students need to bring the form home and then return it to school the next day with a parent signature.
I have found this form to be an effective and respectful way to help manage negative behavior in my classroom.