Perfect "time out" reflection sheet. When a student needed to take a minute off to the side and think about their actions, I would hand this form to the student and they would go to the "think-it-out" seat. They would fill out this form. The student would return to me or place on my desk once finished. We would talk about the sheet once I was done teaching or had a minute. This helped not take time away from my lesson, however I am immediately addressing the behavior. You can either hold on to it and place in student folder, or you can staple in student agenda for parent to sign and return. Its also perfect too because the student is being training to use the cause and effect thinking map (graphic organizer). --What was the event- what caused the event- what were the repercussions and effects because of my event/actions.
Any questions or comments, please feel free to ask away!!