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Office Disciplinary Referral

Office Disciplinary Referral. Put the grade level and circle the gender. Put the students race. This is being used for data collection. Please put the students full name. If student is classified put abbreviation (ex. OHI). Full date and Time. Teachers Name. Location

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Office Disciplinary Referral

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  1. Office Disciplinary Referral

  2. Put the grade level and circle the gender Put the students race. This is being used for data collection. Please put the students full name If student is classified put abbreviation (ex. OHI) Full date and Time Teachers Name

  3. Location Check off where the behavior occurred. ** Remember, the person filling out the report is the teacher/staff member who witnessed the behavior. **

  4. Problem Behaviors Select the problem behavior that was the most severe or intrusive. Please only check one! Again we are keeping track of data.

  5. Possible Motivation • Next, you will fill out the possible motivation behind the problem behavior. • This information would be useful to the teacher or administrator when they may be looking at a behavior that is consistently happening over time and how we can work with student to avoid problem.

  6. Others Involved It is important to fill in what other staff member or peers may have been involved in the problem behavior. Administrators may need this information when looking further into a situation.

  7. Description Include a complete description of what happened, remember to write only what you observed, this is not a place to put assumptions. Make sure you sign and date the referral

  8. Administrator will fill this section in. The form is triplicate and they will get this back to you. Administrative Action

  9. A minor incident report (MIR) can be used to keep record of minor behaviors that may be occurring in your classroom. Many of you already log this information in your own systems. Here a couple other examples that you can use. How can we document minor incidences?

  10. Behavior Journals can be used as a MIR. Students help fill this and are a part of the process of documenting the behavior.

  11. Another example of an MRI. This is formated more for our own matrix of classroom managed behaviors.

  12. After you have noticed a trend (for example, a student repeating the same minor behaviors) you can then fill out a referral and attach your documented MIR’s. This will provide more information for your administrator to work off of. What can we do with a minor incidence report?

  13. Any questions regarding the new referral or office vs. classroom managed behaviors matrix?

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