Behavior Intervention Plan (BIP) Template

Special education form for documenting a behavior intervention plan based on a functional behavioral assessment, including target behaviors, replacement behaviors, supports, implementation, and progress monitoring.

Submission Notice and Privacy

• Submission Type
• Privacy and Record Use Acknowledgement
  I understand this form may contain student PII and will be used for educational planning, implementation, and audit trail purposes in accordance with district policy.
• Authorized Staff Completing This Form
  I confirm I am authorized to enter or review this student support information.
• Submission Date

Student and Team Information

• Student Name
• Student ID
  Use district student ID if available; do not enter SSN.
• School Name
• Grade Level
• Team Members Participating in the Plan
  List the people responsible for assessment, implementation, or monitoring.

Behavioral Concern and FBA Summary

• Target Behavior
  Describe the observable, measurable behavior in specific terms.
• Current Frequency
  Average number of occurrences per day or week.
• Typical Duration
  Example: 5-10 minutes, 1 class period, or until redirected.
• Primary Settings Where Behavior Occurs
• Functional Behavioral Assessment Summary
  Summarize the likely function(s) of the behavior based on the FBA.
• Primary Function of the Behavior

Replacement Behaviors and Proactive Supports

• Replacement Behavior
  Describe the specific, teachable behavior that serves the same function as the target behavior.
• How the Replacement Behavior Will Be Taught
• Proactive Supports
• Antecedent Strategies
  Describe changes to the environment, instructions, or routines that reduce the likelihood of the behavior.

Response, Reinforcement, and Safety

• Reinforcement Strategy
  Describe how appropriate replacement behavior will be reinforced.
• Staff Response to Target Behavior
  Describe the planned adult response, including de-escalation and redirection steps.
• Is There a Safety or Escalation Risk?
• Crisis or Safety Plan
  Only complete if there is a documented safety concern. Include who to contact, when to remove peers, and any approved emergency procedures.

Implementation, Monitoring, and Review

• Primary Implementation Owner
• Progress Monitoring Method
• Baseline Measure
  Enter the starting data point used to compare progress.
• Next Review Date
• Success Criteria
  Define what improvement will look like in observable, measurable terms.