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The Louisiana School Behavior Report Form plays a crucial role in maintaining a safe and productive educational environment. Designed to document behavior incidents occurring on school grounds, this form captures essential details about the event, including the student involved, the time and location of the incident, and the nature of the behavior. It serves not only as a record for school officials but also as a communication tool for parents and guardians, ensuring they are informed of any incidents that may affect their child’s educational experience. The report includes various codes to categorize the incident, such as the motivation behind the behavior and any related influences, which can range from peer pressure to home circumstances. Additionally, the form outlines the actions taken by teachers or school administrators in response to the behavior, whether it be a referral to counseling, detention, or other disciplinary measures. Importantly, it also allows for comments from students and parents, fostering an open dialogue about the incident and its implications. By utilizing this structured approach, schools aim to address behavioral issues effectively while promoting a collaborative effort between educators and families.

Document Example

LOUISIANA DEPARTMENT OF EDUCATION SCHOOL BEHAVIOR REPORT

In accordance with R. S. 17:416(A) the purpose of this report is to inform parents/guardians of a behavior incident on the school campus, in the classroom, cafeteria, gymnasium, auditorium, elsewhere at the school or during school-related activities, and of subsequent disciplinary action taken by school officials. Because this or other incidents may jeopardize the safety, well-being or education of other students, parents are urged to discuss the incident and possible implications with the student to prevent further occurrences.

Name of Student:

 

 

 

 

Phone:

Grade/Section:

 

 

 

 

 

 

 

 

 

 

 

Name of Teacher/Staff:

 

 

 

Teacher/Staff/Location:

 

 

 

 

 

 

 

 

 

 

 

Name of Principal:

 

 

 

 

School:

 

 

 

 

 

 

 

 

 

 

 

 

Check One:

 

 

 

 

Date of Incident:

Time:

Location:

Regular Education

504

Special Education

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Time Code:

01 Before School on Grounds, 02 During Class, 03 Between Classes, 04 After Normal School Hours & Supervised,

 

05 To/From School, 06 At Bus Stop or Transfer Station, 07 During School Extracurricular/Assembly Event, 08

 

Recess, Club, Free Time, 09 Homeroom, 10 Breakfast/Lunch

 

 

 

Location Code:

01 Classroom, 02 Restroom, 03 Lunchroom, 04 Hallway, 05 Playground, 07 At Bus Stop or Transfer Station,

 

08 Parking Lot, 09 Locker Room, 10 Cell Phone, 11 Internet, 12 To or From School, 13 School Sponsored Event,

 

14 Home, 98 Offsite Program, 99 Other

 

 

 

 

 

 

 

 

 

 

 

 

INFRACTION/REASON CODES (Check all that apply)

01.

Willful disobedience

11.

02. Treats an authority with disrespect

03.

Makes an unfounded

12.

 

 

charge against authority

 

04.

Uses profane and/or

13.

 

obscene language

 

 

05. Commits immoral or vicious practices

06. Conduct or habits injurious to his/her associates

07.

Uses or possesses any

14.

 

controlled dangerous

 

 

substances governed by

 

 

the Uniform Controlled

 

 

Dangerous Substances

 

 

Law, in any form

 

08.

Uses or possesses

 

 

electronic vapor

 

 

products, tobacco,

 

 

lighter, or matches

15.

09.

Uses or possesses

 

 

alcoholic beverages

16.

10.

Disturbs the school or

 

habitually violates any rule

Cuts, defaces, or injures

17.

Violates traffic and

36.

Cyber Bullying

any part of public school

 

safety regulations

 

(*complete Bullying Form)

buildings/vandalism

18.

Leaves school premises

37.

False Alarm/Bomb Threat

 

Writes profane and/or

 

or classroom without

38.

Forgery

obscene language or

 

permission

 

39.

Gambling

draws obscene pictures

19.

Is habitually tardy and/

 

40.

Public Indecency

Possesses weapon (s) as

 

or absent

defined in Section 921 of

20.

Takes another’s property

41.

Obscene behavior or

Title 18 of the U.S. Code.

 

or possessions without

 

Possession of Obscene/

*Use of code 13 requires

 

permission

 

Pornographic Material

additional submission of

21.

Commits any other

42.

Unauthorized use of

the Weapon Type code.

Possesses firearms (not

 

serious offense

 

Technology

30.

Discharge or use of

43.

Improper dress

prohibited by federal

law), knives, or other

 

weapon(s) prohibited by

44.

Academic dishonesty

implements, which may

 

federal law

45.

Trespassing Violation

be used as weapons,

31.

Possesses pocket knife

46.

Failure to Serve Assigned

the careless use of which

 

or blade cutter with a

might inflict harm or

 

blade length < 2 ½”

 

Consequence

injury (Excludes pocket

33.

Use of OTC medication

47.

Misusing Internet/

knives with a blade length

 

Violates electronic/

< 2 ½“ - refer to code 31).

 

in a manner other than

 

 

 

technology policy

 

prescribed or authorized

 

 

 

 

Throws missiles liable to

 

 

 

34.

Possession of Body Armor

48.

Sexual Harassment

injure others

 

 

49.

False Report

Instigates or participates

35.

Bullying/Harrassment

 

 

in fights while under

 

(*complete Bullying Form)

50.

Crime of Violence

school supervision

 

 

 

(per R.S. 14:2B)

REMARKS/DESCRIPTION OF INCIDENT:

(REVISED 6/20/2023)

LOUISIANA DEPARTMENT OF EDUCATION SCHOOL BEHAVIOR REPORT

ACTION(S) TAKEN BY TEACHER OR OTHER SCHOOL EMPLOYEE

The student named above is hereby reported for inappropriate behavior as indicated in this report. This is the student’s 1st

2nd 3rd 4th 5th

(circle one) or other

 

cumulative behavioral referral(s). I have taken the following action(s):

 

 

011

Referred to Office

022

Therapeutic Removal

030

Restorative Practices Implemented

012

Referred to Counselor

025

Intervention Room

173

Conference with Parents or Guardians

013

Referred to Social Worker

080

Assigned Remedial Work

175

Conference with Principal

014

Referred to SBLC

120

Student Conference

999

Other Action

 

 

018

Secondary Referral (PBIS)

140

Student Reprimand

 

 

 

 

 

019

Tertiary Referral (PBIS)

160

Loss of Privileges

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contact Parent/Guardian? Y

N

Date:

Time:

 

Phone Call

Letter

Conference Date:

 

Time:

 

 

 

 

 

 

 

 

 

RECOMMENDATION(S) BY TEACHER OR OTHER SCHOOL EMPLOYEE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of School Employee:

 

 

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

ACTION(S) TAKEN BY SCHOOL ADMINISTRATOR

The student named above is hereby reported for inappropriate behavior as indicated in this report. This is the student’s 1st 2nd

3rd

4th

5th

(circle one) or other

 

cumulative behavioral referral(s). I have taken the following action(s):

 

 

 

 

 

 

000

No Action – only use if no

 

 

 

 

 

014

Referred to School Building Level

080

Assigned Remedial Work

 

 

 

 

reportable action was taken

 

 

 

 

 

Committee (SBLC)

 

 

 

 

 

 

 

 

 

120

Student Conference Date:

 

 

 

001

Expulsion Recommendation

 

 

 

016

Court Referral Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

140

Student Reprimand

 

 

 

 

 

 

002

Suspension Out of School

 

 

 

 

 

017

Enforcement Referral (Arrest

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

160

Loss of Privileges

 

 

 

 

 

 

 

from

 

to

 

 

 

 

 

 

 

 

 

Resulted Y N)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

173

Conference w/ Parents or

 

 

 

004

Suspension In School from

 

 

 

to

 

020

TOR (Time Out Room)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Guardians on:

 

 

 

 

 

 

 

006

Suspension Alternative Site

 

 

 

030

Restorative Practices Implemented

 

 

 

 

 

 

 

 

 

 

175

Conference w/ Principal on:

 

 

 

 

from

 

to

 

 

 

 

 

 

 

040

In School Detention from

 

to

 

 

 

 

 

 

 

 

 

 

 

180

Corporal Punishment (if checked,

012

Referred to Counselor

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

043

After School Detention from

 

 

 

 

to

 

 

 

complete “Corporal Punishment”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

013

Referral to Social Worker

 

 

 

 

 

045

Weekend Detention from

 

to

 

Incidence Checklist)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

999

Other Action(s):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Perpetrator: Serious Bodily Injury

 

Y

 

 

N

Medical Treatment Y

N Victim: Serious Bodily Injury

Y N Medical Treatment

 

Y

N

 

 

 

 

 

 

 

 

 

 

 

 

 

Contact Parent/Guardian? Y

 

 

N

Date:

Time:

Phone Call

 

 

 

Letter

Conference Date:

Time:

 

 

 

 

 

 

 

 

 

 

 

SIS Primary Infraction/Reason Code Entered:

 

Signature of Principal:

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMMENTS BY STUDENT AND/OR PARENT/GUARDIAN:

Signature of Student:

Signature of Parent/Guardian:

Current Date:

Check appropriate blocks as copies of the document are supplied:

Parent/Guardian

School’s Pupil File

Employee Filing this Report

Principal

*NOTE: The principal shall return a completed copy of this form to the staff

member who initiated the referral within 48 hours

(excluding non-work days) of the time it was submitted to the principal.

**Attachments: Provide copies of all documents related to the behavior of the student named above and prepared by the employee submitting this referral.

(REVISED 6/20/2023)

Dos and Don'ts

When filling out the Louisiana School Behavior Report form, it is essential to follow certain guidelines to ensure accuracy and clarity. Below is a list of five things you should and should not do.

  • Do provide accurate information about the incident, including the date, time, and location.
  • Do clearly describe the behavior incident in the remarks section to provide context.
  • Do check all relevant boxes for the type of incident and motivations involved.
  • Do ensure that all signatures are obtained from the appropriate parties.
  • Do keep a copy of the completed form for your records.
  • Don't leave any sections blank, as this may lead to confusion or misinterpretation.
  • Don't use vague language in the description of the incident; specificity is crucial.
  • Don't forget to discuss the incident with the student before submitting the report.
  • Don't submit the form without reviewing it for errors or omissions.
  • Don't disclose sensitive information that is not relevant to the incident.

Detailed Instructions for Filling Out Louisiana School Behavior Report

Completing the Louisiana School Behavior Report form is an important task that helps ensure clear communication between the school and parents or guardians regarding student behavior incidents. After filling out this form, it will be submitted to the appropriate school officials for further action and documentation.

  1. Gather Information: Before you start filling out the form, collect all necessary information about the incident, including the student's name, grade, and the teacher or staff involved.
  2. Fill in Student Details: Write the name of the student, their phone number, and their grade or section at the top of the form.
  3. Teacher/Staff Information: Enter the name of the teacher or staff member who is reporting the incident, along with the room number or location where the incident occurred.
  4. Principal's Name: Fill in the name of the principal and the name of the school.
  5. Select Education Type: Check the appropriate box for the student's education type: Regular Education, 504, or Special Education.
  6. Date and Time: Record the date and time of the incident. Be sure to note the location as well.
  7. Time and Location Codes: Use the provided codes to indicate when and where the incident took place. Fill in the corresponding codes in the designated areas.
  8. Motivation and Influences: Check the relevant motivation codes and related influences that may have contributed to the incident.
  9. Injury and Medical Treatment: Circle "Yes" or "No" for any serious bodily injury or medical treatment for both the perpetrator and victim.
  10. Incident Codes: Check all applicable primary incident reason codes that relate to the behavior incident.
  11. Description of Incident: Provide a detailed description of the incident in the remarks section. Be clear and concise.
  12. Actions Taken: Indicate the actions taken by the teacher or school employee, circling the appropriate cumulative referral number.
  13. Contact Parent/Guardian: Record whether the parent or guardian was contacted, including the date and time of contact.
  14. Recommendations: Write any recommendations made by the teacher or school employee in the designated area.
  15. School Administrator Actions: If applicable, the school administrator should fill out their section, indicating the actions taken and signing the form.
  16. Comments by Student/Parent: Provide space for comments from the student and/or parent or guardian at the end of the form.
  17. Signatures: Ensure both the student and parent or guardian sign the form along with the current date.
  18. Distribution: Check the appropriate boxes to indicate who will receive copies of the report.

Documents used along the form

The Louisiana School Behavior Report form serves as a crucial tool for documenting behavioral incidents within educational settings. However, several other forms and documents often accompany it to provide a comprehensive understanding of a student's behavior and the actions taken in response. Below are some of these essential documents.

  • Classroom Minor Tracking Form: This form is used to document minor behavioral incidents that occur in the classroom. Teachers record specific behaviors, interventions attempted, and the outcomes. It helps in identifying patterns over time and provides a basis for further action if necessary.
  • Power of Attorney document: Understanding legal forms is crucial for effective decision-making, as seen in the Power of Attorney form, which allows individuals to designate someone to manage their affairs.
  • Behavior Intervention Plan (BIP): A BIP is developed for students who exhibit chronic behavioral issues. It outlines specific strategies and interventions tailored to the individual needs of the student. The plan aims to promote positive behavior while addressing the underlying causes of the disruptive actions.
  • Data Collection Sheets: These sheets are utilized to gather quantitative data regarding a student's behavior over a specified period. They help educators track the frequency, duration, and context of behavioral incidents, facilitating informed decision-making regarding interventions and supports.
  • Incident Report Form: This document is used for more serious behavioral incidents that may require formal reporting. It provides a detailed account of the incident, including the context, individuals involved, and any immediate actions taken. This form is vital for maintaining accurate records for administrative review and potential disciplinary actions.

Together, these documents work in conjunction with the Louisiana School Behavior Report form to create a well-rounded approach to managing student behavior. They enable educators to address issues effectively while fostering a supportive environment for all students.

Your Questions, Answered

What is the purpose of the Louisiana School Behavior Report form?

The Louisiana School Behavior Report form is designed to inform parents and guardians about behavior incidents that occur on school grounds or during school-related activities. It details the nature of the incident and any disciplinary actions taken by school officials. This form aims to ensure that parents are aware of incidents that could affect the safety and education of their child and others.

What information is included in the report?

The report includes several key pieces of information:

  • Name of the student involved
  • Date and time of the incident
  • Location of the incident
  • Type of education program (Regular Education, 504, or Special Education)
  • Details about the incident, including motivations and influences
  • Actions taken by school staff
  • Recommendations for further action

This comprehensive information helps to clarify the circumstances surrounding the incident.

What should parents do upon receiving the report?

Upon receiving the report, parents should take the time to discuss the incident with their child. It is essential to understand the context and implications of the behavior. Engaging in an open conversation can help prevent future occurrences and support the child's emotional and social development. Parents may also consider reaching out to school officials for clarification or to discuss further actions.

What types of disciplinary actions can be taken?

Disciplinary actions can vary based on the severity of the incident. Some common actions include:

  1. Referred to office or counselor
  2. Detention (in-school or after school)
  3. Suspension (in-school or out-of-school)
  4. Restorative practices
  5. Loss of privileges

The specific action taken will depend on the nature of the incident and the school's policies.

How does the report help improve school safety?

The report plays a critical role in enhancing school safety by documenting incidents and the responses to them. By keeping a record, schools can identify patterns of behavior and take proactive measures to address issues. This process not only helps in managing individual cases but also contributes to creating a safer environment for all students. Collaboration between parents, students, and school officials is vital in this effort.

Common mistakes

Filling out the Louisiana School Behavior Report form can be a straightforward process, but many people make mistakes that can lead to confusion or miscommunication. One common error is failing to provide complete information about the student. The name, grade, and section are essential for identifying the student involved in the incident. Missing this information can delay the disciplinary process and create unnecessary complications.

Another frequent mistake is neglecting to specify the date and time of the incident accurately. These details are crucial for understanding the context of the behavior. If the date or time is incorrect, it can lead to misunderstandings about when the incident occurred and may affect the school's response.

Additionally, people often overlook the importance of selecting the correct location and time codes. The form provides various options to choose from, and selecting the wrong ones can misrepresent where the incident took place. This can hinder the school's ability to address the issue appropriately and may lead to further incidents in the same location.

Some individuals also fail to check all relevant motivation codes. The motivations behind a student's behavior can provide insight into why the incident occurred. Not marking these codes can limit the school's understanding of the situation and prevent them from addressing underlying issues effectively.

In the remarks section, a lack of detail can be problematic. Providing a clear and thorough description of the incident is vital. Vague statements can lead to different interpretations and may not provide enough information for school officials to take appropriate action.

Moreover, people sometimes forget to indicate whether medical treatment was needed for either the perpetrator or the victim. This information is important for ensuring the safety and well-being of all students involved. Omitting this detail can lead to inadequate follow-up care.

Another common oversight is not circling the correct cumulative behavioral referral number. This number helps track a student's behavioral history. Failing to circle the correct number can misrepresent how many incidents a student has had, impacting future disciplinary actions.

Lastly, signatures are crucial. Some individuals may forget to sign the form or ensure that all necessary parties, such as parents or guardians, sign it as well. Without these signatures, the report may not be considered valid, and the school may not be able to proceed with the necessary actions.

Misconceptions

Misconceptions about the Louisiana School Behavior Report form can lead to misunderstandings about its purpose and use. Here are nine common misconceptions:

  • 1. The form is only for serious incidents. Many believe that the report is reserved for severe behaviors only. In reality, it is designed to document a range of behaviors, from minor infractions to serious offenses, to ensure a comprehensive understanding of student conduct.
  • 2. Parents are not involved in the process. Some think that the report is solely for school records. However, it emphasizes parental involvement by encouraging discussions between parents and students about incidents.
  • 3. The report is punitive in nature. There is a misconception that the form's primary purpose is to punish students. Instead, it aims to inform and facilitate interventions that can help students improve their behavior.
  • 4. Only teachers can fill out the report. Many assume that only teachers have the authority to complete the report. In fact, any school employee witnessing an incident can document it using this form.
  • 5. The report leads directly to expulsion. Some believe that filling out the form automatically results in severe disciplinary actions, like expulsion. This is not true; the report serves as a starting point for assessing the situation and determining appropriate responses.
  • 6. All incidents require immediate suspension. It is a common misconception that every reported behavior leads to suspension. The form allows for various responses, including counseling or restorative practices, which may be more suitable for certain incidents.
  • 7. The report does not consider context. Some people think the form treats all incidents equally, without context. In reality, it includes sections for motivations and influences, allowing for a more nuanced understanding of each situation.
  • 8. The report is only for behavioral issues. There is a belief that the form is limited to behavior-related incidents. However, it also addresses issues like bullying, substance abuse, and other factors that can impact student well-being.
  • 9. Once submitted, the report is not revisited. Many assume that the report is a one-time document that is filed away. In fact, it is part of an ongoing process that may involve follow-up actions and assessments based on the reported behavior.

Understanding these misconceptions can help parents, students, and educators engage more effectively with the Louisiana School Behavior Report form and promote a positive school environment.

Document Attributes

Fact Name Details
Purpose of the Report The Louisiana School Behavior Report Form is designed to inform parents or guardians about behavior incidents that occur on school grounds or during school-related activities.
Governing Law This report is governed by Louisiana Revised Statute 17:416(A), which outlines the responsibilities of schools in addressing student behavior.
Incident Locations Incidents can take place in various locations, including classrooms, cafeterias, gymnasiums, and during extracurricular activities.
Types of Actions Taken School officials may take various actions, such as referrals to counselors, loss of privileges, or restorative practices, depending on the severity of the incident.
Parental Involvement Parents are encouraged to discuss the incident with their child to prevent future occurrences, highlighting the importance of communication in addressing behavioral issues.