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Run: Behavior Intervention Plan (BIP) Template

A Behavior Intervention Plan (BIP) template for documenting target behaviors, replacement skills, supports, staff responses, and progress monitoring after an...

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Submission Notice and Privacy

Submission Type (required)

Privacy and Record Use Acknowledgement (required)

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.

Yes No N/A

Authorized Staff Completing This Form (required)

I confirm I am authorized to enter or review this student support information.

Yes No N/A

Submission Date (required)

Student and Team Information

Student Name (required)

Student ID

Use district student ID if available; do not enter SSN.

School Name (required)

Grade Level (required)

Team Members Participating in the Plan (required)

List the people responsible for assessment, implementation, or monitoring.

Behavioral Concern and FBA Summary

Target Behavior (required)

Describe the observable, measurable behavior in specific terms.

Current Frequency (required)

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 (required)

Functional Behavioral Assessment Summary (required)

Summarize the likely function(s) of the behavior based on the FBA.

Primary Function of the Behavior (required)

Replacement Behaviors and Proactive Supports

Replacement Behavior (required)

Describe the specific, teachable behavior that serves the same function as the target behavior.

How the Replacement Behavior Will Be Taught (required)

Proactive Supports (required)

Antecedent Strategies (required)

Describe changes to the environment, instructions, or routines that reduce the likelihood of the behavior.

Response, Reinforcement, and Safety

Reinforcement Strategy (required)

Describe how appropriate replacement behavior will be reinforced.

Staff Response to Target Behavior (required)

Describe the planned adult response, including de-escalation and redirection steps.

Is There a Safety or Escalation Risk? (required)

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 (required)

Progress Monitoring Method (required)

Baseline Measure (required)

Enter the starting data point used to compare progress.

Next Review Date (required)

Success Criteria (required)

Define what improvement will look like in observable, measurable terms.

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