BI Weekly Behavior Report

Over the last week my child's behavior *
Please respond to the following questions *
 YesNoNumber of Times
Broke the house rules?
Broke the school's rules?
Phone calls from school?
School suspensions?
Acted physically aggressive?
Makes threats of violence?
Seriously hurt anyone?
Suicidal thoughts/comments?
Homicidal thoughts/comments?
Self-injurious behavior such as cutting or scratching?
Crying episodes?
Run away?
Hurt any animals?
Set any fires?
Police contact?
Innappropriate sexual behavior?
Innappropriate sexual touching?
See therapist willingly?
See Behavioral Interventionist willingly?
Have you seen any progress since your child began working with the Behavioral Interventionist?