Woodcock interpretation and instructional interventions program Schrank ◆ Wendling ◆ Woodcock

Classroom Behavior Observation Form

Student’s Name (Last)______________________________________ (First)_ _______________________ Date_______________________
Teacher’s Name (Last) ____________________________________________________________________ Time_______________________
Observer’s Name (Last)____________________________________ (First)_ _______________________

Part I: Time Sampling of Behavior

At the end of each 30-second interval, first observe the comparison student’s behavior and place a + in the column for on-
task behavior or a – for off-task behavior. Then observe the referred student. Record a + or a – as before. Categorize the
referred student’s problem behaviors by placing a check mark in the appropriate column. Make brief notes to help identify the
antecedents, consequences, or perceived reason for the problem behavior.


Problem Behaviors (Referred Student)

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Notes
30 sec
1 min
30 sec
2 min
30 sec
3 min
30 sec
4 min
30 sec
5 min
30 sec
6 min
30 sec
7 min
30 sec
8 min
30 sec
9 min
30 sec
10 min
30 sec
11 min
30 sec
12 min
30 sec
13 min
30 sec
14 min
30 sec
15 min

B. Off-task totals for referred student (number of – marks)

A. Off-task totals for comparison student (number of – marks)

Classroom Behavior Observation Form accompanying the Woodcock Interpretation and Instructional
Interventions Program © 2008 by The Riverside Publishing Company. All rights reserved.
Permission is granted to reproduce this form. 1
Part II: Problem Behaviors Observed  ncooperative behavior. Was the student uncooperative?
D. U
For example, did he or she refuse to follow instructions or
Sum the Problem Behaviors columns in Part I. If the student did rules, act defiantly, argue or talk back to the teacher, pout,
not demonstrate the following problem behaviors, check Not refuse to take turns or share, or cheat?
Observed. If the problem behavior was observed, check Yes,
❏ 1. Not Observed
note the specific behavior, then rate the levels of severity (to
❏ 2. Yes (describe)
self) and disruptiveness (to others).

A. Inattentiveness. Did the student have difficulty paying a. Severity. How seriously did this behavior impede the
attention, sustaining alertness, or maintaining effort? For student’s opportunity to learn?
example, did he or she look around, fail to listen to instructions ❏ 1. Not seriously
or lessons, or become distracted by extraneous stimuli? ❏ 2. Slightly seriously
❏ 1. Not Observed ❏ 3. Seriously
❏ 2. Yes (describe) ❏ 4. Very seriously
b. Disruptiveness. How disruptive was this behavior to others?
a. Severity. How seriously did this behavior impede the ❏ 1. Not disruptive
student’s opportunity to learn? ❏ 2. Slightly disruptive
❏ 1. Not seriously ❏ 3. Moderately disruptive
❏ 2. Slightly seriously ❏ 4. Very disruptive
❏ 3. Seriously
 nxiousness. Did the student appear overtly anxious?
E. A
❏ 4. Very seriously
For example, did he or she pull his or her hair, bite his or
b. Disruptiveness. How disruptive was this behavior to others? her nails, twitch, pace, shake, repetitively tap his or her
❏ 1. Not disruptive hands or feet, show a tense or worried expression, tremble,
❏ 2. Slightly disruptive complain of a stomachache, or cry?
❏ 3. Moderately disruptive ❏ 1. Not Observed
❏ 4. Very disruptive
❏ 2. Yes (describe)
 veractivity. Was the student overly active for his or her
B. O
age or grade? For example, did he or she fidget or jump a. Severity. How seriously did this behavior impede the
out of his or her seat, walk or run around the classroom student’s opportunity to learn?
inappropriately, or sit or stand on a desk? ❏ 1. Not seriously
❏ 1. Not Observed ❏ 2. Slightly seriously
❏ 2. Yes (describe) ❏ 3. Seriously
❏ 4. Very seriously
a. Severity. How seriously did this behavior impede the b. Disruptiveness. How disruptive was this behavior to others?
student’s opportunity to learn? ❏ 1. Not disruptive
❏ 1. Not seriously ❏ 2. Slightly disruptive
❏ 2. Slightly seriously ❏ 3. Moderately disruptive
❏ 3. Seriously ❏ 4. Very disruptive
❏ 4. Very seriously
 ithdrawal. Did the student seem to withdraw from others
F. W
b. Disruptiveness. How disruptive was this behavior to others?
or from the classroom activities? For example, did he or
❏ 1. Not disruptive she stare blankly or daydream, inappropriately fiddle with
❏ 2. Slightly disruptive objects, or appear sullen or detached?
❏ 3. Moderately disruptive
❏ 4. Very disruptive ❏ 1. Not Observed
❏ 2. Yes (describe)
C. Impulsiveness. Did the student act impulsively? For
example, did he or she blurt out answers before questions a. Severity. How seriously did this behavior impede the
were completed, interrupt others, butt into conversations or student’s opportunity to learn?
games, or fail to wait for a turn? ❏ 1. Not seriously
❏ 1. Not Observed ❏ 2. Slightly seriously
❏ 2. Yes (describe) ❏ 3. Seriously
❏ 4. Very seriously
a. Severity. How seriously did this behavior impede the b. Disruptiveness. How disruptive was this behavior to others?
student’s opportunity to learn? ❏ 1. Not disruptive
❏ 1. Not seriously ❏ 2. Slightly disruptive
❏ 2. Slightly seriously ❏ 3. Moderately disruptive
❏ 3. Seriously ❏ 4. Very disruptive
❏ 4. Very seriously
b. Disruptiveness. How disruptive was this behavior to others?
❏ 1. Not disruptive
❏ 2. Slightly disruptive
❏ 3. Moderately disruptive
❏ 4. Very disruptive

Classroom Behavior Observation Form 2

G. Aggressiveness. Did the student act aggressively to B. C
 onsidering the primary problem behavior identified,
other people or property? For example, did he or she hit, kick, please complete the following sentences to describe
bite, pinch, scratch, push, throw objects at, or spit at another; what typically happened immediately prior to and
threaten, bully, or verbally abuse another; or break, deface, or immediately after the problem behavior occurred.
destroy things? You may also develop a hypothesis about the reason
❏ 1. Not Observed for the problem behavior.
❏ 2. Yes (describe) ❏ 1. Immediately before the problem behavior occurred,

a. Severity. How seriously did this behavior impede the

student’s opportunity to learn? ❏ 2. Right after the behavior occurred,
❏ 1. Not seriously
❏ 2. Slightly seriously
❏ 3. Seriously ❏ 3. This behavior may have occurred because
❏ 4. Very seriously
b. Disruptiveness. How disruptive was this behavior to others?
❏ 1. Not disruptive
 ype of activity or activities observed. (Check all that
C. T
❏ 2. Slightly disruptive
apply.)
❏ 3. Moderately disruptive
❏ 4. Very disruptive ❏ 1. Teacher-directed large classroom activity
❏ 2. Small group activity
 ther inappropriate behaviors (nonaggressive). Did the
H. O ❏ 3. One-to-one instruction
student behave in ways that were socially inappropriate or ❏ 4. Individual activity (seatwork)
offensive to others? For example, did he or she swear or use
vulgar language, tease others, tattle on others, talk too loudly, D. Does the student wear glasses?
bother others who were trying to work, talk nonsense, pick his ❏ 1. No
or her nose, belch, expel gas, or touch his or her genitals? ❏ 2. Yes
❏ 1. Not Observed If Yes, was the student wearing them during the observation?
❏ 2. Yes (describe) ❏ a. No
❏ b. Yes
a. Severity. How seriously did this behavior impede the
student’s opportunity to learn? E. Does the student wear a hearing aid?
❏ 1. Not seriously ❏ 1. No
❏ 2. Slightly seriously ❏ 2. Yes
❏ 3. Seriously If Yes, was the student wearing it during the observation?
❏ 4. Very seriously ❏ a. No
b. Disruptiveness. How disruptive was this behavior to others? ❏ b. Yes
❏ 1. Not disruptive
❏ 2. Slightly disruptive F. Does the student take medication for behavior?
❏ 3. Moderately disruptive ❏ 1. No
❏ 4. Very disruptive ❏ 2. Yes
If Yes, was the student on medication during the observation?
Part III: Review of Classroom Observation ❏ a. No
❏ b. Yes
A. R
 eview the problem behaviors identified in Part II. G. According to the teacher, was the student’s behavior
Identify the primary problem behavior observed. during the observation typical of that student?
(Check one.) ❏ 1. No
❏ 1. No serious problem behaviors were observed ❏ 2. Yes
❏ 2. Inattentiveness
If no, the teacher reported the student’s behavior was not
❏ 3. Overactivity
typical because
❏ 4. Impulsiveness
❏ 5. Uncooperative behavior
❏ 6. Anxiousness
❏ 7. Withdrawal
❏ 8. Aggressiveness
❏ 9. Nonaggressive, classroom-inappropriate behaviors
❏ 10. Other

Classroom Behavior Observation Form 3