Universal Behavior Screening
Universal Behavior Screening
Adapted from Student Risk Screening Scale (SRSS) (Drummond, 1994) and Student Internalizing Behavior Screening Scale (SIBSS) Teacher:
LEP
5
10
15
Student Name
Totals A-G
504
Date:
1. List first and last name of each student in your class under student name. 2. In the first column, indicate students who are identified as SPED (Special Education and/or speech), 504 or LEP (Limited English Proficient). 3. Reflect on each student’s behavior during the past month. Then rate each student on each behavior using the following scale: 0 = NEVER, 1 = RARELY, 2 = OCCASSIONALLY, 3 = FREQUENTLY 4. Total columns A-G and record in column after student name. Total columns G-M and record in last column. *Note-column G is included in both totals.
A SPED
School:
Nervous or fearful
B Bullied by peers
C
D
E
F
*G
Spends time alone
Withdrawn
Sad or unhappy
Complaints about being sick or hurt
Low Academic Achievement
H
I
J
K
L
M
Stealing
Lying Cheating Sneaking
Behavior Problems
Peer Rejection
Negative Attitude
Aggressive Behaviors
Totals G-M
Directions:
Grade:
SPED 504 LEP
20
25
30
35
Student Name
Totals A-G
A Nervous or fearful
B Bullied by peers
C
D
E
F
*G
Spends time alone
Withdrawn
Sad or unhappy
Complaints about being sick or hurt
Low Academic Achievement
H
I
J
K
L
M
Stealing
Lying Cheating Sneaking
Behavior Problems
Peer Rejection
Negative Attitude
Aggressive Behaviors
Totals G-M
0 = NEVER, 1 = RARELY, 2 = OCCASSIONALLY, 3 = FREQUENTLY
Adapted from Student Risk Screening Scale (SRSS) (Drummond, 1994) and Student Internalizing Behavior Screening Scale (SIBSS) Teacher:
LEP
5
10
15
Student Name
Totals A-G
504
Date:
1. List first and last name of each student in your class under student name. 2. In the first column, indicate students who are identified as SPED (Special Education and/or speech), 504 or LEP (Limited English Proficient). 3. Reflect on each student’s behavior during the past month. Then rate each student on each behavior using the following scale: 0 = NEVER, 1 = RARELY, 2 = OCCASSIONALLY, 3 = FREQUENTLY 4. Total columns A-G and record in column after student name. Total columns G-M and record in last column. *Note-column G is included in both totals.
A SPED
School:
Nervous or fearful
B Bullied by peers
C
D
E
F
*G
Spends time alone
Withdrawn
Sad or unhappy
Complaints about being sick or hurt
Low Academic Achievement
H
I
J
K
L
M
Stealing
Lying Cheating Sneaking
Behavior Problems
Peer Rejection
Negative Attitude
Aggressive Behaviors
Totals G-M
Directions:
Grade:
SPED 504 LEP
20
25
30
35
Student Name
Totals A-G
A Nervous or fearful
B Bullied by peers
C
D
E
F
*G
Spends time alone
Withdrawn
Sad or unhappy
Complaints about being sick or hurt
Low Academic Achievement
H
I
J
K
L
M
Stealing
Lying Cheating Sneaking
Behavior Problems
Peer Rejection
Negative Attitude
Aggressive Behaviors
Totals G-M
0 = NEVER, 1 = RARELY, 2 = OCCASSIONALLY, 3 = FREQUENTLY
