This data form is a way to analyze student's breaks within the Special education classroom. It allows you to determine which areas of your day may be overwhelming your students or which areas they may need additional support. It is also a great way to see if certain students are consistently missing certain subjects or task demands. The columns that look at independent or prompted breaks will help you determine if students need more instruction on how take a break before they become dysregulated. And the data will allow you to determine if your class, or certain students are ready to have time limits placed on their breaks.
Hope you find it useful!