The Louisiana School Behavior Report Form serves as a crucial tool for documenting behavioral incidents that occur on school grounds or during school-related activities. This form not only informs parents and guardians about incidents involving their children but also details the disciplinary actions taken by school officials. It is essential for parents to engage in discussions with their children regarding these incidents to foster a safer and more supportive educational environment.
To ensure your child's well-being and to take appropriate action, please fill out the form by clicking the button below.
The Louisiana School Behavior Report Form serves as a vital tool for documenting incidents of inappropriate behavior occurring within school settings. This form is designed to inform parents and guardians about specific behavioral incidents that take place on campus or during school-related activities. It captures essential information, including the student's name, grade, and the location and time of the incident. Additionally, the form categorizes the type of incident and the motivations behind the behavior, allowing for a comprehensive understanding of the circumstances. It also includes sections for school officials to record any disciplinary actions taken, which can range from referrals to counseling or detention to more serious consequences like suspension or expulsion. The report emphasizes the importance of parental involvement in addressing behavioral issues, urging discussions between parents and students to prevent future occurrences. By systematically recording these incidents, the form aims to enhance the safety and well-being of all students within the educational environment.
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.
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
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
50.
Crime of Violence
school supervision
(per R.S. 14:2B)
REMARKS/DESCRIPTION OF INCIDENT:
(REVISED 6/20/2023)
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:
Phone Call
Letter
Conference Date:
RECOMMENDATION(S) BY TEACHER OR OTHER SCHOOL EMPLOYEE:
Signature of School Employee:
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
000
No Action – only use if no
Referred to School Building Level
reportable action was taken
Committee (SBLC)
Student Conference Date:
001
Expulsion Recommendation
016
Court Referral Date:
002
Suspension Out of School
017
Enforcement Referral (Arrest
from
to
Resulted Y N)
Conference w/ Parents or
004
Suspension In School from
020
TOR (Time Out Room)
Guardians on:
006
Suspension Alternative Site
Conference w/ Principal on:
040
In School Detention from
180
Corporal Punishment (if checked,
043
After School Detention from
complete “Corporal Punishment”
Referral to Social Worker
045
Weekend Detention from
Incidence Checklist)
Other Action(s):
Perpetrator: Serious Bodily Injury
Y
Medical Treatment Y
N Victim: Serious Bodily Injury
Y N Medical Treatment
SIS Primary Infraction/Reason Code Entered:
Signature of Principal:
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.
Completing the Louisiana School Behavior Report form requires careful attention to detail. This form serves as a communication tool between the school and the parents or guardians regarding behavioral incidents. To ensure that the information is accurately recorded, follow these structured steps.
After completing the form, it should be submitted to the principal, who will return a completed copy to the initiating staff member within 48 hours. This process ensures that all parties are informed and that appropriate follow-up actions can be taken.
The Louisiana School Behavior Report form is designed to inform parents or guardians about behavior incidents that occur on school grounds or during school-related activities. It serves as a communication tool between the school and home, ensuring that parents are aware of any issues that may affect their child's safety, well-being, or educational experience. The form also outlines the disciplinary actions taken by school officials in response to the incident.
The form requires various details to provide a comprehensive overview of the incident. Key information includes:
Upon receiving the Louisiana School Behavior Report, parents are encouraged to discuss the incident with their child. Open communication can help address the behavior and its implications. Parents should consider the following steps:
The form outlines a variety of disciplinary actions that school officials may implement based on the severity and nature of the incident. Some common actions include:
Each action aims to address the behavior while also providing support to the student to encourage positive change.
When a student receives multiple behavior reports, it indicates a pattern of behavior that may require additional intervention. The form allows school officials to track the number of cumulative referrals. Depending on the frequency and severity of incidents, schools may take more serious actions, such as:
Ultimately, the goal is to support the student in making better choices and improving their behavior.
Incomplete Student Information: Failing to fill out all required fields such as the student’s name, grade, and teacher’s name can lead to confusion and delays in processing the report.
Incorrect Incident Date or Time: Entering the wrong date or time of the incident can affect the investigation and response from school officials.
Missing Location Codes: Not selecting the correct location code can result in misunderstandings about where the incident took place, which is crucial for context.
Omitting Motivation Codes: Failing to check the motivation codes can prevent staff from understanding the underlying reasons for the behavior, making it harder to address the issue effectively.
Inaccurate Reporting of Actions Taken: Not clearly stating the actions taken by the teacher or school employee can lead to miscommunication about how the situation was handled.
Neglecting Parent/Guardian Contact: Forgetting to document the contact made with the parent or guardian can result in a lack of follow-up and support for the student.
The Louisiana School Behavior Report form is a vital document for tracking and managing student behavior incidents in schools. However, it is often accompanied by several other forms and documents that help provide a comprehensive view of a student's behavior and the actions taken. Below is a list of these additional forms, each serving a unique purpose in the behavior management process.
These documents work together to create a well-rounded approach to behavior management in schools. By utilizing them effectively, educators can foster a supportive environment that promotes positive behavior and addresses challenges proactively.
The Louisiana School Behavior Report form shares similarities with the Incident Report form commonly used in workplaces. Both documents serve to formally document occurrences of inappropriate behavior or incidents that may disrupt the environment, whether in a school or workplace setting. Each report typically includes details such as the date, time, and location of the incident, as well as descriptions of the behavior observed. Furthermore, both forms often require the identification of individuals involved, including witnesses, and may outline any actions taken in response to the incident. This structured approach helps ensure that all relevant information is captured, providing a clear record for future reference.
Another document that resembles the Louisiana School Behavior Report form is the Disciplinary Action Notice. This notice is used by schools and organizations to inform individuals about the consequences of their actions. Like the behavior report, it details the nature of the incident, including specific behaviors that led to disciplinary measures. The Disciplinary Action Notice typically outlines the steps taken by authorities, such as warnings or suspensions, and may also include recommendations for future behavior. Both documents aim to communicate the seriousness of the situation to the involved parties, promoting accountability and encouraging reflection on the behavior in question.
The Student Conduct Report is another document that parallels the Louisiana School Behavior Report form. This report focuses on documenting student behavior in relation to established conduct codes within educational institutions. It includes similar elements, such as the date and location of the incident, the behavior exhibited, and any disciplinary actions taken. The Student Conduct Report is often utilized to track patterns of behavior over time, providing educators and administrators with insights into a student’s conduct history. Both forms emphasize the importance of maintaining a safe and respectful environment for all students.
In addition, the Bullying Incident Report shares common features with the Louisiana School Behavior Report form. This report specifically addresses incidents of bullying, providing a detailed account of the event, including the individuals involved and the context of the behavior. Like the behavior report, it aims to document the incident thoroughly to ensure appropriate follow-up actions are taken. Both documents prioritize the safety and well-being of students, encouraging open communication between school officials, parents, and students to address and prevent further occurrences.
Lastly, the Behavioral Referral Form used in many schools is quite similar to the Louisiana School Behavior Report form. This form is utilized to refer a student to a counselor or administrator for behavioral issues. It captures essential information about the incident, including the nature of the behavior and any prior interventions attempted. Both forms emphasize the importance of addressing behavior in a constructive manner, often leading to discussions about potential solutions and support for the student. By documenting these incidents, schools can work collaboratively with families to foster positive behavior changes.
When filling out the Louisiana School Behavior Report form, there are specific actions to take and avoid. Adhering to these guidelines will ensure clarity and accuracy in reporting.
Misconception 1: The Louisiana School Behavior Report form is only for serious incidents.
This form is used for a variety of behavioral incidents, not just the severe ones. It addresses minor issues as well, helping schools track and manage all types of behavior. By reporting even small incidents, schools can work towards preventing bigger problems in the future.
Misconception 2: Parents do not need to be involved in the process.
Parents are a crucial part of this process. The form is designed to inform them about incidents involving their child. This communication allows parents to engage in discussions with their child about behavior and its consequences, fostering a supportive environment for improvement.
Misconception 3: The report only serves as a punishment tool.
The primary goal of the Louisiana School Behavior Report form is not punishment, but rather to promote understanding and improvement. It documents incidents to help educators identify patterns and provide necessary support to students. The focus is on corrective action and guidance.
Misconception 4: All incidents reported lead to severe disciplinary actions.
Not every reported incident results in severe consequences. The form outlines a range of actions that can be taken, depending on the nature of the behavior. Many responses aim to educate and support the student rather than simply discipline them. This approach can lead to more positive outcomes for students in the long run.
The Louisiana School Behavior Report form serves as an important communication tool between schools and parents. It documents behavioral incidents that occur on campus or during school-related activities.
When filling out the form, it's essential to include detailed information about the incident. This includes the date, time, and location, as well as the motivations behind the behavior and any related influences.
Parents are encouraged to discuss the incident with their child. Understanding the context can help prevent future occurrences and support the child's emotional and educational needs.
The form includes various codes to classify the incident, such as the type of behavior and the actions taken by school staff. Accurate coding is crucial for proper record-keeping and analysis.
Finally, after the form is completed, it must be returned to the initiating staff member within 48 hours. This ensures timely communication and follow-up regarding the student's behavior and any necessary interventions.