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Run: Functional Behavioral Assessment (FBA) Form

Functional Behavioral Assessment (FBA) Form for documenting antecedents, observable behavior, consequences, and suspected function so a team can build a beha...

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Assessment Context and Consent

Student Name (required)

Enter the student's full name for record matching.

Student ID

Optional school identifier if needed for internal record matching.

Grade Level (required)

Assessment Date (required)

Date the FBA is being completed.

Assessor Name (required)

Name of the staff member completing this form.

Reason for Assessment (required)

Briefly describe the behavior concern and why the FBA is being completed.

Consent / Disclosure Acknowledgement (required)

Confirm that any required notices, consent, or disclosure steps have been handled according to school policy and applicable law.

Yes No N/A

Target Behavior Definition

Target Behavior Name (required)

Short label for the behavior being assessed.

Operational Definition of Behavior (required)

Describe exactly what the behavior looks and sounds like. Avoid vague terms such as 'disruptive' or 'defiant' without observable details.

Behavior Type (required)

Select all behavior categories that apply.

Baseline Frequency

Approximate number of occurrences per day, week, or class period if known.

Baseline Duration

If known, describe how long the behavior typically lasts (for example, '5-10 minutes').

Behavior Intensity

Antecedents and Setting Events

Antecedents / Triggers (required)

Select the events or conditions that occurred immediately before the behavior.

Setting Events

Select any broader factors that may have influenced the behavior.

Antecedent Narrative (required)

Describe the situation leading up to the behavior, including task demands, environment, and adult prompts.

Location

Where the behavior occurred, if relevant.

Time of Day

Behavior and Consequence Details

Behavior Description (required)

Describe the behavior as observed, using objective language.

Number of Occurrences

How many times the behavior occurred during the incident or observation period.

Duration

How long the behavior lasted, if known.

Immediate Consequence (required)

Select what happened right after the behavior.

Consequence Narrative (required)

Describe the response from staff, peers, and the environment after the behavior occurred.

Function Hypothesis and Team Plan

Suspected Function of Behavior (required)

Select the most likely reason the behavior is occurring based on the available data.

Evidence Summary (required)

Summarize the patterns or observations that support the suspected function.

Replacement Behavior to Teach

Describe the skill or alternative behavior the student should be taught to use instead.

Recommended Supports

Select supports to consider in the behavior intervention plan.

Follow-Up Date

Date for team review or next meeting.

Submission and Audit Trail

Submitted By (required)

Name of the person submitting the form.

Role (required)

Additional Notes

Include any other relevant observations, team decisions, or documentation notes.

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