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Outline

The Louisiana School Behavior Report Form is a crucial tool designed to address and document behavioral incidents that occur within school environments. This form serves multiple purposes: it informs parents or guardians about specific incidents involving their children, outlines the disciplinary actions taken by school officials, and encourages open communication between families and schools. The report captures essential details, such as the student’s name, grade, and the location of the incident, whether it occurred in a classroom, cafeteria, or during extracurricular activities. It categorizes incidents based on various motivations and influences, allowing educators to identify underlying issues that may affect student behavior. Furthermore, the form includes a section for school staff to detail actions taken in response to the behavior, whether it involves referrals to counselors, disciplinary measures, or restorative practices. By providing a structured approach to reporting, the Louisiana School Behavior Report Form not only aims to ensure student safety and well-being but also fosters a collaborative effort to address and prevent future incidents.

Sample - Louisiana School Behavior Report Form

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)

Form Information

Fact Name Details
Governing Law The Louisiana School Behavior Report form is governed by R.S. 17:416(A).
Purpose This report informs parents or guardians about behavior incidents occurring on school grounds or during school-related activities.
Incident Locations Behavior incidents can occur in various locations, including classrooms, cafeterias, and during extracurricular activities.
Motivation Codes The form includes motivation codes to help identify why a student may have engaged in a particular behavior.
Disciplinary Actions Actions taken by school officials can range from referrals to counseling to suspension or expulsion recommendations.
Reporting Requirements School officials must return a completed copy of the report to the initiating staff member within 48 hours.
Parent Communication Schools are required to contact parents or guardians regarding the incident and any actions taken.

Detailed Guide for Filling Out Louisiana School Behavior Report

Completing the Louisiana School Behavior Report form is a critical step in addressing behavioral incidents in schools. This process ensures that all necessary information is documented accurately, allowing for appropriate follow-up actions. Follow these steps carefully to fill out the form correctly.

  1. Gather necessary information: Collect details about the student, including their name, phone number, and grade/section.
  2. Identify the reporting staff: Write the name of the teacher or staff member completing the report, along with their room number and location.
  3. Principal details: Fill in the name of the principal and the school name.
  4. Incident specifics: Record the date and time of the incident, as well as the location. Select the appropriate time and location codes from the provided options.
  5. Motivation and influences: Choose the motivation code that best describes why the incident occurred. Mark any related influences such as drugs or alcohol.
  6. Injury and medical treatment: Circle “Yes” or “No” for both the perpetrator and victim regarding serious bodily injury and medical treatment.
  7. Behavioral codes: Check all relevant codes that apply to the incident, including primary incident/reason codes.
  8. Incident description: Provide a detailed description of the incident in the remarks section. Be clear and concise.
  9. Actions taken: Indicate the actions taken by the teacher or other school employee regarding the incident. Circle the appropriate cumulative behavioral referral number.
  10. Parent contact: Note whether the parent/guardian was contacted and record the date and time of the contact method used.
  11. Recommendations: Write any recommendations by the teacher or other school employee in the designated section.
  12. Administrator actions: If applicable, fill out the actions taken by the school administrator, including any disciplinary measures implemented.
  13. Student and parent signatures: Ensure that both the student and parent/guardian sign the form, along with the current date.
  14. Document copies: Check the appropriate boxes to indicate where copies of the report should be sent.

After completing the form, submit it to the principal. The principal will return a completed copy to the staff member who initiated the referral within 48 hours, excluding non-work days. Ensure that all attachments, such as the classroom minor tracking form or behavior intervention plan, are included as necessary.

Obtain Answers on Louisiana School Behavior Report

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

    The Louisiana School Behavior Report form serves a crucial role in maintaining a safe and conducive learning environment. It is designed to inform parents or guardians about behavioral incidents that occur on school grounds, during classes, or at school-related activities. This report outlines the nature of the incident and any disciplinary actions taken by school officials. By keeping parents informed, the school encourages discussions that can help prevent future occurrences and ensure the well-being of all students.

  2. Who receives the Louisiana School Behavior Report form?

    The report is directed primarily to the parents or guardians of the student involved in the incident. Additionally, copies are maintained in the school's pupil file and provided to the employee who initiated the report, as well as the principal. This multi-copy system ensures that all relevant parties are aware of the incident and the actions taken, fostering transparency and accountability within the school environment.

  3. What information is required on the form?

    The form requires various details to accurately document the incident. Key information includes:

    • Name and grade of the student involved
    • Name of the teacher or staff member reporting the incident
    • Date, time, and location of the incident
    • Nature of the incident, including motivation and related influences
    • Actions taken by school personnel
    • Signatures of the student and parent or guardian

    This comprehensive data collection helps schools address behavioral issues effectively and tailor interventions to individual student needs.

  4. What types of incidents are reported on this form?

    The form encompasses a wide range of incidents, including but not limited to:

    • Assault or battery
    • Possession of weapons or controlled substances
    • Disruptive behavior during classes or school activities
    • Serious bodily injury to oneself or others
    • Sexual harassment or misconduct

    By categorizing incidents, the form aids in identifying patterns of behavior that may require further intervention or support.

  5. What actions can school officials take following a reported incident?

    Upon receiving a report, school officials have several options for addressing the behavior. Actions may include:

    • Referring the student to a counselor or social worker
    • Assigning detention or remedial work
    • Implementing restorative practices
    • Recommending suspension or expulsion in severe cases

    These measures aim to not only discipline but also to provide support and resources to help students improve their behavior and succeed academically.

Common mistakes

Filling out the Louisiana School Behavior Report form can be a straightforward process, but several common mistakes can lead to complications. One frequent error is failing to provide complete information about the incident. All sections of the form, including the name of the student, date, time, and location of the incident, must be filled out accurately. Incomplete information can delay the review process and hinder effective communication between the school and parents.

Another common mistake is neglecting to check all relevant boxes. The form includes various checkboxes for educational classifications, motivations, and influences. Omitting these details can result in an inaccurate representation of the incident. It's essential to carefully consider each option and check all that apply to ensure a comprehensive understanding of the situation.

Misunderstanding the codes used on the form is also a frequent issue. Each section, from location codes to motivation codes, has specific meanings that must be adhered to. If the wrong code is selected, it can lead to misinterpretation of the behavior incident, which may affect the disciplinary actions taken. Familiarity with these codes is crucial for accurate reporting.

Additionally, some individuals fail to provide a clear description of the incident in the remarks section. This section is vital for explaining the context and specifics of the behavior that occurred. Vague or incomplete descriptions can leave school officials without the necessary information to address the situation properly.

Another mistake involves not documenting the actions taken by the teacher or school employee. This section is critical for tracking the response to the incident and ensuring that appropriate measures are in place. If this information is missing, it can complicate follow-up actions and communication with parents.

Forgetting to include signatures can also be problematic. The form requires the signatures of both the student and the parent or guardian. Without these signatures, the report may be considered incomplete, leading to potential delays in processing the incident.

Lastly, some individuals overlook the importance of timely submission. The principal is required to return a completed copy of the form within 48 hours. Delays in submission can hinder the effectiveness of the reporting process and may impact the resolution of the incident. Adhering to deadlines is essential for maintaining a smooth communication flow between the school and families.

Documents used along the form

The Louisiana School Behavior Report form is an essential tool for documenting behavioral incidents in schools. However, it is often used in conjunction with several other forms and documents that help provide a comprehensive approach to managing student behavior. Here are some commonly used forms that complement the School Behavior Report:

  • Classroom Minor Tracking Form: This form records minor behavioral incidents that occur in the classroom. It helps teachers monitor patterns of behavior over time and can be used to inform future interventions.
  • Behavior Intervention Plan (BIP): A BIP outlines specific strategies and interventions tailored to address a student's behavioral challenges. It is developed collaboratively and is crucial for supporting students with ongoing behavioral issues.
  • Incident Report Form: This document provides a detailed account of a specific incident involving a student. It includes information about what happened, who was involved, and the response from school staff, ensuring that all incidents are thoroughly documented.
  • Referral to Counselor Form: When a student's behavior indicates a need for additional support, this form is used to refer the student to a school counselor. It outlines the reasons for the referral and any prior interventions attempted.
  • Parent Communication Log: This log tracks communications between school staff and parents regarding a student's behavior. It helps ensure that parents are kept informed and involved in addressing their child's behavioral issues.
  • Disciplinary Action Form: This form documents any disciplinary actions taken in response to a student's behavior. It includes details about the incident, the actions taken, and any follow-up required, ensuring accountability and transparency in the process.

Using these forms in conjunction with the Louisiana School Behavior Report form helps create a comprehensive approach to managing student behavior. Each document plays a vital role in fostering communication, accountability, and support within the school environment.

Similar forms

The Louisiana School Behavior Report form serves as a critical tool for documenting behavioral incidents in schools. It shares similarities with several other important documents used in educational settings. Here’s a breakdown of eight such documents:

  • Incident Report Form: Like the Louisiana School Behavior Report, this form is used to document specific incidents that occur within the school environment. It details the nature of the incident, involved parties, and any actions taken, ensuring that all incidents are formally recorded.
  • Disciplinary Action Form: This document outlines the disciplinary measures taken against a student following a behavioral incident. It parallels the Louisiana form by providing a structured way to communicate actions taken by school officials.
  • Behavior Intervention Plan (BIP): A BIP is designed for students who require additional support to manage their behavior. Similar to the Louisiana form, it includes information on the student’s behavior and outlines strategies for improvement.
  • Parent Communication Log: This log tracks communications between the school and parents regarding student behavior. It aligns with the Louisiana form’s emphasis on parental involvement in addressing behavioral issues.
  • Referrals to Counseling: When a student is referred to counseling, documentation is created to outline the reasons for the referral and any recommended actions. This is akin to the referral process detailed in the Louisiana School Behavior Report.
  • Student Performance Report: This report provides insights into a student’s academic and behavioral performance. Like the Louisiana form, it aims to keep parents informed about their child’s progress and challenges.
  • Safety Incident Report: Used to document incidents that may threaten the safety of students or staff, this report serves a similar purpose to the Louisiana School Behavior Report by ensuring that safety concerns are formally recorded and addressed.
  • Attendance Report: This document tracks student attendance and may include notes on absences related to behavioral issues. It parallels the Louisiana form in its role of monitoring student well-being and engagement in school.

Understanding these documents can help parents and guardians better navigate the school environment and support their children effectively. Each serves a unique purpose but collectively contributes to a safe and supportive educational experience.

Dos and Don'ts

When filling out the Louisiana School Behavior Report form, it is essential to follow specific guidelines to ensure clarity and accuracy. Here’s a list of things you should and shouldn’t do:

  • Do provide accurate and complete information about the incident, including the date, time, and location.
  • Do check all relevant boxes for motivations and influences related to the behavior.
  • Do describe the incident clearly in the remarks section to give context.
  • Do sign the report and ensure that all required signatures are included.
  • Do keep a copy of the completed report for your records.
  • Don't leave any sections blank unless specified; incomplete forms may lead to misunderstandings.
  • Don't use vague language; be specific about the behavior and actions taken.

By adhering to these guidelines, you can help ensure that the report serves its purpose effectively. Timely and accurate reporting is crucial for the well-being of all students involved.

Misconceptions

Misconceptions about the Louisiana School Behavior Report form can lead to confusion among parents, students, and educators. Here are five common misconceptions:

  • 1. The form is only for serious incidents. Many believe the form is only necessary for major offenses. In reality, it is used for a wide range of behaviors, including minor infractions, to ensure that all incidents are documented and addressed.
  • 2. Parents are not involved in the process. Some think that parents do not need to be informed unless the situation escalates. However, the form is designed to keep parents in the loop from the start, allowing for discussions about behavior and prevention strategies.
  • 3. The report affects the student's permanent record. There is a misconception that every report will have a lasting impact on a student's academic record. While the form is important for tracking behavior, not all incidents lead to disciplinary action that affects a student’s overall record.
  • 4. Only teachers can fill out the form. Many believe that only teachers have the authority to complete the report. In fact, any school employee who witnesses an incident can document it, ensuring that all relevant behaviors are reported.
  • 5. The form is not taken seriously by school officials. Some think that the report is merely a formality and that school officials do not act on it. In truth, the form is a critical tool for addressing student behavior and ensuring a safe learning environment.

Key takeaways

Filling out and using the Louisiana School Behavior Report form requires attention to detail and understanding of the process. Here are some key takeaways to keep in mind:

  • Purpose: The report informs parents or guardians about behavior incidents that occur on school grounds or during school-related activities.
  • Discussion: Parents should discuss the incident with their child to understand its implications and prevent future occurrences.
  • Accurate Information: Ensure all fields, such as student name, grade, and incident details, are filled out accurately.
  • Incident Codes: Familiarize yourself with the various codes for time, location, and motivation to select the appropriate ones for the incident.
  • Behavior Categories: Identify and check all relevant behavior categories that apply to the incident.
  • Actions Taken: Clearly document actions taken by the teacher or school employee, such as referrals or disciplinary measures.
  • Parent Contact: Contact the parent or guardian promptly, noting the method and date of communication.
  • Principal’s Role: The principal must review and sign the report, ensuring that appropriate actions are taken.
  • Student and Guardian Signatures: Obtain signatures from both the student and guardian to acknowledge receipt of the report.
  • Documentation: Keep copies of the report for school records and provide necessary attachments, such as behavior intervention plans.

Following these guidelines will help ensure that the report serves its intended purpose and supports a positive school environment.