Functional Behavior Assessment Form Pdf Details

A Functional Behavioral Assessment (FBA) is a process of systematic inquiry used to assess the function of a student’s problem behavior. FBAs are conducted with the purpose of understanding why a student is engaging in problem behaviors and then developing interventions that target the function of the behavior. FBA can be helpful for educators who are looking to design individualized interventions for students who engage in problem behaviors. In this blog post, we will provide an overview of what FBAs involve and discuss some considerations when conducting an FBA. Stay tuned for our next blog post where we will share intervention ideas that can be implemented following an FBA.

You will see information about the type of form you wish to prepare in the table. It will tell you the time it should take to fill out functional behavioral assessment, what fields you will need to fill in and several other specific details.

Form NameFunctional Behavioral Assessment
Form Length3 pages
Fillable fields0
Avg. time to fill out45 sec
Other namesfunctional assessment interview form, functional behavioral assessment template, functional behavior pdf, functional assessment interview

Form Preview Example

Functional Behavioral Assessment: Part 1 (Description) Date: ______________

Student Name: __________________________ ID: ___________________ DOB: ____________ Case Manager: _______________________

Data Sources: ¨ Observation | ¨ Student Interview | ¨ Teacher Interview | ¨ Parent Interview | ¨ Rating Scales | ¨ Normative Testing

Description of Behavior (No. ____):

Setting(s) in which behavior occurs:


Intensity (Consequences of problem behavior on student, peers, instructional environment):


Describe Previous Interventions:

Educational impact:

Page ____ of ____

Name: _________________

Functional Behavioral Assessment: Part 2 (Function)

Date: ______________



Function of Behavior (No. ____): Specify hypothesized function for each area checked below.


¨Affective Regulation/Emotional Reactivity (Identify emotional factors; anxiety, depression, anger, poor self-concept; that play a role in organizing or directing problem behavior):

¨Cognitive Distortion (Identify distorted thoughts; inaccurate attributions, negative self-statements, erroneous interpretations of events; that play a role in organizing or directing problem behavior):

¨Reinforcement (Identify environmental triggers and payoffs that play a role in organizing and directing problem behavior):



¨Modeling (Identify the degree to which the behavior is copied, who they are copying the behavior from, and why they are copying the behavior):

¨Family Issues (Identify family issues that play a part in organizing and directing problem behavior):

¨Physiological/Constitutional (Identify physiological and/or personality characteristics; developmental disabilities, temperament; that play a part in organizing and directing problem behavior):

¨Communicate need (Identify what the student is trying to say through the problem behavior):

¨Curriculum/Instruction (Identify how instruction, curriculum, or educational environment play a part in organizing and directing problem behavior):

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Behavioral Intervention Plan


Date: __________

Student Name: ______________________________


ID: _________________ DOB: ______________

Case Manager: _____________________









Expected Outcome(s)


Intervention(s) &







Frequency of Intervention



Review Notes








* Review Codes: GA = Goal Achieved | C = Continue | DC = Discontinue

Expected Review Dates: __________ | __________ | __________

Signatures: _____________________










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