This Hall Pass serves double duty! It not only serves the purpose of a hall pass (giving a student proof that permission has been granted to leave the classroom to go to the bubbler, bathroom, nurse, etc.) but it also serves as a record of how many times a student has asked to leave the classroom.
How I use this pass in my classroom: Students in my classroom are allotted 5 hall passes per quarter. I print these passes on brightly colored paper (double sided), cut them out, and give one to each student on the first day of school. I explain to students that it is extremely important to be PRESENT in class, which means you can't ask to go to the bathroom everyday, multiple times a day. They print and sign their name in pen on the front after we go over the rules of the "Hall Pass" and they are kept in a box at the front of my classroom.