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0.78 MB | 5 pages
Special Education: IEP Functional Behavior Assessment & Behavior Intervention Support Plan Template
This is a PDF template that is “form field fillable” including text form fields and check boxes. The template is 5 pages: (1) Coversheet for demographics, (2) FBA and (2) BIP. The entire template is fillable, savable and printable.
When completing the FBA for more than 1 Target Behavior, simply fill in the FBA template, assign a file name to it and save it. Then fill it in again with the next target behavior. This can be done over and over. The same applies to the BIP.
Below is a list of sections included in the FBA and the BIP.
Functional Behavioral Assessment
Description of Target Behavior in Observable Terms:
Time: When is the target behavior most likely to occur?
Morning at Approximate Time:
Afternoon at Approximate Time:
Various times throughout the day (pattern noted)
Sporadic times throughout the day (no pattern noted)
Time of day does not seem to affect this behavior
Location: Where is the target behavior most likely to occur?
All Classrooms Specific Classroom:
Cafeteria Gymnasium Library Hallway Bathroom
Location does not seem to affect this behavior
Activity: What activity/task is most likely to trigger the target behavior?
Group Activities Independent Seatwork Unstructured Activities
Transitional Times Unstructured Activities Directives from Authority
Being told “no” Called on to respond aloud Provocation from Peers
Schedule change Denied immediate attention Corrected in front of others
Waiting for a turn Visitor enters the room Attention given to others
Demand/Request Difficult/New Task Arriving without materials
Consequences: What reinforces the student to demonstrate the target behavior?
Teacher Attention Teacher Directives
Peer Attention Peer Interactions
Desired Activity Undesirable/Difficult Activity or Task
Power & Control over others Removal from the setting
Desired Item (tangible) Subsequent Classes
Becomes the center of attention Avoids being the center of attention
Function of the Behavior: Hypothesis Statement
Behavior Intervention Plan
Area of Disability
BIP Developed on
Anticipated Review Date(s
Summary of Problem Behaviors
Baseline Data of Problem Behaviors
Method(s) of Teaching Replacement Behaviors
Method(s) and Frequency of Measuring Progress
Consequences for Behaviors
Signature, Title, Date
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