FBA Teacher Questionnaire

Functional Behavior Assessment — Teacher/Staff Input

A Functional Behavior Assessment (FBA) gathers information about behaviors of concern. Your classroom observations are critical to identifying patterns, triggers, and effective strategies. Please answer as specifically as possible.

Student & Teacher Information

Student's Name (First and Last) *

Today's Date *

Teacher Name *

Grade / Subject / Class Period *

Behavior of Concern

Describe the specific behavior(s) of concern. What does it look, sound, or feel like? * Be specific and observable — e.g. "leaves seat without permission" rather than "disruptive"

Frequency, Duration & Intensity

How often does this occur?

How long does each episode last?

How intense / disruptive?

Antecedents & Triggers

When is the behavior MOST LIKELY to occur in the classroom? * e.g. during independent work, transitions, after lunch, when given multi-step directions

When is the behavior LEAST LIKELY to occur? * e.g. during preferred activities, 1:1 instruction, small group

Describe any additional antecedent details:

Strategies & Interventions Attempted

Which strategies have been most effective? Which have not worked? *

Student Strengths & Additional Context

What are this student's academic and social strengths in your classroom? *

What motivates this student? What do they respond positively to? * e.g. praise, choice, technology, movement, working with peers

Is there any additional information you would like to share?

Signature

Teacher Signature *

Date *