kccsteachersandstaff.weebly.com · Web view9/03 The Picture Communication Symbols (PCS) copyright ©1981-2003 Mayer-Johnson, Inc. Used with permission. 9/03 The Picture Communication

A Manual of Examples& Ideas for Teachers

Adapted from a manual developed by members of the Behavior Support Team

South Central Area ESE, Broward County Public Schools June, 2001

Revised: September, 2003

Contributing Members of the Behavior Support Team: Kelly BernalHymle Greenfield Lori Hansberger Marian Klinger

Suzanne Korngold Tracy Moss Lorenzo

WoodEileen Schroth, Desktop Publisher, District ESE

The School Board of Broward County, Florida

Lois Wexler Chair

Carole L. Andrews Vice

Chair

Judie S. Budnick Darla L. Carter

Beverly A. Gallagher

Stephanie Arma Kraft, Esq.Robert D. Parks, Ed. D. Marty Rubinstein Benjamin J. Williams

Dr. Frank Till Superintendent of

Schools

The School Board of Broward County, Florida, prohibits any policy or procedure which results in discrimination on the basis of age, color, disability, gender, national origin,

marital status, race, religion, or sexual orientation.

Exceptional Student Education and Florida Diagnostic Learning Resource Systems

DataCollection

9/03

CLASSWORK LOG

Student Name: Grade:

School:

Subject:

Date

+ / 0

Date

+ / 0

Date

+ / 0

Date

+ / 0

Date

+ / 0

Date

+ / 0

9/03

HOMEWORK LOG


School: Subject:

Date

+ / 0

Date

+ / 0

Date

+ / 0

Date

+ / 0

Date

+ / 0

Date

+ / 0

9/03

Student Name:

Dates:

Observer:

Dates

Activity/Time

9/03

Behavior Tally Form

Student Name: Week of: Target Behavior:

Monday

Tuesday

Wednesday

Thursday

Friday

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

16 17 18 19 20 21 22 23 24 25

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

16 17 18 19 20 21 22 23 24 25

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

16 17 18 19 20 21 22 23 24 25

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

16 17 18 19 20 21 22 23 24 25

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

16 17 18 19 20 21 22 23 24 25

9/03

Scatterplot

Student Name: Behavior to record:

Recorder:

Dates:

Time ActivityDate: Date: Date: Date: Date:

= Behavior occurred

= Behavior did NOT occur

= Did not observeX N/A

9/03

Data Sheet

Student Name: Date:

School:

Observer: # of Students:

Activity:

Time started: Time ended: Total Time:

Total time on task: Total time off task:



Comparison Student Date:

Observer:

Activity:



9/03

Dat

e&

Time Comments

Dat

e&

Time Comments

9/03

ABC Anecdotal Sheet

School:

Student: Teacher:

Date/Activity A (Antecedent) B (Behavior) C (Consequence)

Behavior Charts

and Reports

Elementary

My Behavior ChartStudent Name: School:

Circle Lunch

Story Time Outside

Choice Nap

Specials Snack

I earned happy faces!

I got to pick a prize: Yes No

Parent Signature:

Teacher Comments:

9/03The Picture Communication Symbols (PCS) copyright ©1981-2003 Mayer-Johnson, Inc.—Used with permission.

Name Date

My Teacher:

Time Activity

Teacher Assistant:

Speech Teacher:

Helping Teacher:

= Successful during time block

= Unsuccessful during time block

Need 9out of 12


My

Goal:

I

can do it!

My Reward:

+o


Name Date

lunch

nap

recess

Specials

J

ournal

Math

The

me Activity

Reading Centers

seat work handwriting

Social Science Studies

8 Means Great!!


needs to:

To earn a sticker,

TARGET GOAL: Keep Hands , Fe e t, and Ob je cts to Sel f

use nice words

u

sa a quiet voice us

e objects the right way

wal

k quietly with arms and hands to self


You must earn happy faces to receive a reward


Morning Procedures

Name:

mail

money

lunch box

chairpocket

chair

greet

teacher

sit onthe floor

waterbottle

backpack

nametag

classbooklibrary

book

poetrybook

bookpouch

f

older

ta

lk tofriends


Daily Report

Name:

HAPPY OKAY SADCLAS

S RULES

I will listen to the teacher. I will stay in my seat/area. I will do all my work.I will keep my hands, feet,

Rea

ding

centers/

puzzle

language activity

lunc

h

academi

c

game

Math Seat

Work

stor

y time computer

sp

ecials

Teacher signature:

Parent signature:

Did not make day Made day Yo

u need happy faces to make your day.

Daily Progress Report

Name:

Date:

9/03

1. Follow teacher and staff directions

2. Stay in my seat/workarea

3. Complete each work task

4. Keep hands, feet, and objects to self

Parent signature:

Teacher signature:

happy faces to receive a reward at the end of each day.

Yo

u need

kfast

k

g

s

Daily Progress Report

Name:

Behavior:

Date:

SCHEDULE FINISHED

9/03The Picture Communication Symbols (PCS) copyright ©1981-2003 Mayer-Johnson, Inc. Used with permission.

Freetime

Science orSocial Studies

Special

Math

SharedReadin

Lunch

Spelling/Language Arts

Centers

Reading

Journal/Boardwor

Brea

listen stay in seat

raise hand

show respect

Comments: Returned Homework

Parent Signautre


Name: Date:

Time Activity

My Behavior

Comments: Returned Homework

Parent Signautre


Name: Date:

Time Activity

My Behavior

Followed Directions

Stayed In Area

Controlled Voice &

Body


S

‘s work assignments

Raise my hand for help.

tay in my seat.

My workReward

1.

2.

3.

4.

5.

6.

Shhh!

Work quietly!


’s ChartReward:

To get my reward, I must:

My workRules

RewardShhh!

1.

2.

3.

4.

5.

6.


Monitoring SheetName: Date:

Raised Hand(independently)

Called Out

Time: Goal Time: Goal

Total Total


Remained In Area

Out of Area


Total Total


On Task Looks Like:

Off Task Looks Like:


Total Total

9/03

Parent SignatureRequested

BEH AVIOR CL A S S TI M E

My Goal(s):

Name:

Date:


BEH AVIOR CL A S S TI M E

My Goal(s):

Name:

Date:

9/03

Work to do on Date

Name:

Morning — I will do * work first

Afternoon — I will do * work first

* Work To Do Time Started Time Done Teacher

Evaluation: Check your answer.

My work was finished on time. Yes NoMy work is neat.I gave my best effort.

Yes Yes

No No

* Work To Do Time Started Time Done Teacher

9/03

Daily ReportName:

Date:

Follow directions the first time

Stay on task

Raise hand to speak or leave seat

Respect self and others

Use correct language and behavior

TARGET:

COMMENTS: HOMEWORK:

Teacher Signature Parent Signature

Daily ReportName:

Date:

Follow directions the first time

Stay on task

Raise hand to speak or leave seat

Respect self and others

Use correct language and behavior

TARGET:

COMMENTS: HOMEWORK:

9/03

Teacher Signature Parent Signature

9/03

Self-Monitoring SheetName:

Date:

My Goals

I will remain in my desk or assigned area.

I will work quietly.

I will use polite language.

I will follow directions from an adult.

Self-Monitoring SheetName:

Date:

My Goals

I will remain in my desk or assigned area.

I will work quietly.

I will use polite language.

I will follow directions from an adult.

9/03

Name: Date:

My Teacher:

Time Activity

Need out of 8

= Successful during time block

= Unsuccessful during time block


My

Goal:

summe

r

schoo

l

Comments:

My Reward:+

o

Behavior Charts

and Reports

Secondary

9/03

Weekly Behavior Monitor

Student Name: Week Of:

Performance Checklist Monday Tuesday Wednesday Thursday Friday

1. Arrives on time2. Attendance3. Brings Materials4. Gets Ready for first activity5. Appropriate behavior6. Remains on task7. Follow directions8. Participates9. Completes Assignments10. Notebook Organized

KEY: S = Satisfactory N = Needs Improvement U = Unsatisfactory

Comments:

Teacher Signature:

Student Signature:

Parent Signature:

9/03

Daily Behavioral and Academic Monitoring Sheet


Return To: Date:

TEACHER: Please use ink to indicate behavior. 4 = Excellent 3 = Good 2 = Needs Improvement 1 = Poor 0 = Nothing Completed/Referral Given

SUBJECTStayed

On Task

Completed Class Work

Completed Homework Teacher Comments

Reading

Language Arts

Math

Science

Social Studies

Elective

9/03

Name: Date:

Teachers: Write YES or NO in columns and initial.

Parent Signature:

SUBJECT Good Behavior

Stays On Task

Completes Task

Asks for Help

Has HW Turned in HW

9/03


7th Period:

6th Period:

5th Period:

4th Period:

3rd Period:

2nd Period:

1st Period:

TEA C H ER I N ITIA L S CLA S S

My Goal(s):

Name:

Date:


7th Period:

6th Period:

5th Period:

4th Period:

3rd Period:

2nd Period:

1st Period:

TEA C H ER I N ITIA L S CLA S S

My Goal(s):

Name:

Date:

9/03

Daily Progress Report Scoring Key: 4 = Excellent (No prompts needed) 3 = Satisfactory (1 or 2 reminders)

Name:

Date:

2 = Fair (Needed redirection) 1 = Poor (Several warnings)0 = Unsatisfactory (Was given a consequence)

Behavior Goals: 1st Hour 2nd Hour 3rd Hour 4th Hour 5th Hour 6th Hour 7th Hour

Total Points Earned:

Teacher: Assignment: Due Date:

9/03

Progress Report

To: Course:

From: Name:

Date:

Grade:

Please check the appropriate item for the period of: to

ACADEMICS RATING Tests A B C D F IClasswork A B C D F IHomework A B C D F I

ATTENDANCE

Satisfactory Unsatisfactory

BEHAVIOR Satisfactory

Needs Improvement Unsatisfactory

Additional Comments:

Teacher Signature:

Parent Signature:

Student Signature:

9/03

Student Monitoring Sheet

Teacher: Student: Grade:Course/Period: Exceptionality:

Please check the appropriate item for the period of: to

Behavior Monitored Scale

Attends class 5 4 3 2 1

Arrives on time to class 5 4 3 2 1

Follows directions 5 4 3 2 1

Stays in seat/area 5 4 3 2 1

Attentive in class 5 4 3 2 1

Remains quiet 5 4 3 2 1

Completes assigned work 5 4 3 2 1

Submits assigned work 5 4 3 2 1

Submits assigned homework 5 4 3 2 1

Good grades on daily work 5 4 3 2 1

Good grades on tests 5 4 3 2 1

Other: 5 4 3 2 1

Other:

Comments:

5 4 3 2 1

9/03

What’s Happening?

Teacher:

M LA SC SS R

Student:Week of:

Grade:

Exceptionality:

Monday:

Tuesday:

Wednesday:

Thursday:

Comments:

Home Note

Teacher: Date:

Student:

1 = Independence level was high, needed few prompts.2 = Independence level was moderate, needed some prompting. 3 = Independence level was low, needed several prompts.

Behavior

1. Remained in assigned area. Yes No I tried2. Kept my hands to myself. Yes No I tried3. Followed directions. Yes No I tried

9/03The Picture CommunicationS ymbols (PCS) copyright 1981-2003 Mayer-Johnson, Inc. Used with permission.

321

Grou

p

321

Independen

t work

321

O

ne to One

321

brea

k time

321

Use

d his words

321

compute

r

321

fo

llowed schedule

321

t

ransitioning

321

CBI

trip

321

outside

321

lunch

321

grooming

Parent Comments Teacher Comments

ContractBetween

School, Home & Others

9/03

Progress Report

Return To: By:

Teacher: Course:

Student: Grade:Period: Date:

Behavior Being Monitored Satisfactory Unsatisfactory

Class Attendance

Promptness to Class

General Attitude

Classroom Behavior

Academics: Rating:

Tests A B C D F I

Classwork A B C D F I

Homework A B C D F I

Grade Last Quarter:

Comments:

9/03

Student Intervention ChecklistStudent:Team: Grade Level:Parent/Guardian: Phone:

DATE ALL ENTRIESClassroom InterventionsSeat ChangeBehavior Reflection AssignmentTime Out to Another ClassroomDaily/Weekly Progress ReportDetentionConflict Mediation/Peer CounselingCurriculum ModificationBehavior ContractMentoringPositive ReferralLoss of Hall Privileges Between Classes

Student/Teacher Conference

Teacher/ParentPhone CallParent/Student ConferenceLetter to ParentPre Referral

Pre Detention

Team/Guidance CounselorGuidance ReferralInitiate Child Study Team

Othe

r Interventions Used: (Explanation and Date)

9/03

Team Teacher Conference Form

School:Student: Grade:Conference: Telephone Conference: Date:

Notes from discussion held in conference:

Problem(s) Identified:

Solution with plan of action:

Student Signature:

Parent Signature:

Teacher/Team Member (Signatures)

English: Elective: Math: Elective: Science: Guidance: Social Studies: Other: Reading:

9/03

Consultation Form

From:

School

:Student:

Date:

Teacher: Team:Class:

Consultation With: ESE Teacher Classroom Teacher Speech Therapist School Psychologist OT/PT ESE Specialist Administrator Guidance Counselor Support Facilitator Parent Family Counselor Other

Concerns:

Attempted Interventions:

Suggestions/Ideas:

What’s Next?

9/03

Parent Contact Documentation Form

Student: Parent:

Date and Time of Contact: Type of contact: phone call detention notice letter informal meeting home visit meeting with administrator meeting with counselor other:

Person initiating the contact:

Topics discussed:

Steps parent will take:

Steps teacher will take:

Additional notes:

9/03

Report to Parents Report to Parents

Student: Date:

Student: Date:

1. Work completed in class: All Most Little None

1. Work completed in class: All Most Little None

2. The work completed was: Superior Good Poor

2. The work completed was: Superior Good Poor

3. Behavior was: Excellent Good Poor

3. Behavior was: Excellent Good Poor

Hands to self: Yes Remained in seat: Yes Polite language: Yes

No No No

Hands to self: Yes Remained in seat: Yes Polite language: Yes

No No No

4. Homework was: Not returned

4. Homework was: Not returned

Good GoodPoor Poor

5. Tonight there is homework: Yes

5. Tonight there is homework: Yes

No No

Name

Date

Please sign and return!

Name

Date

Please sign and return!

9/03

Weekly Home Note

Student: Date:

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Teacher Signature

Parent Signature

9/03

Daily Home Note

Student: Date:

My day was: becuase:

These are the things I did well:

I need to work on:

Homework or Upcoming Events:

Teacher Signature

Parent Signature

9/03

Daily Home Note

Student: Date:

I earned “Caught Being Good” tickets today because I followed these class rules:

Follow directions

Raise hand/speak with permission

Keep hands, feet, and objects to yourself

Sit in seat properly

Show respect to others and their property

Other:

My chart filled up! I earned:

I had some problems today, and I need to work on:

Consequence:

Teacher Signature

Parent Signature

9/03

Daily Home Note

Student:

Date:

My day was : because:

I remained in class and in my assigned area.

Yes No

I kept my hands and feet to myself. Yes No

I used appropriate language. Yes No

I completed my class assignments& waited for help if I needed it.

Yes No

I asked for help if I felt angry or worried.

Yes No

I followed directions from school personnel.

Yes No

Teacher Signature

Parent Signature

9/03

Weekly Home Note For: Day & Date Homework Behavior Parent Signature

Monday I earned Points

I ..... Made My DayDid Not Make My Day

See Note

Tuesday I earned Points


See Note

Wednesday I earned Points


See Note

Thursday I earned Points


See Note

Friday I earned Points


See Note

9/03

Weekly Home Note For: Day & Date Homework Behavior Parent Signature

Monday

See Note

Tuesday

See Note

Wednesday

See Note

Thursday

See Note

Friday

See Note

9/03

Spelling—ABC OrderSpelling—Write words in sentences. Spelling—Write words times each.Math EnglishOther

Spelling—ABC OrderSpelling—Write words in sentences. Spelling—Write words times each.Math EnglishOther

Homework

Homework

CopyrightInformation

ayer-Johnson, Inc. (800) 588-4548 9/4/03 3:06 PM

Copyright Guidelines for Legal Usage of the Mayer-Johnson Picture Communication Symbols (PCS)

Selling or giving away materials using the PCS in paper or software form is illegal without the permission of Mayer-Johnson, Inc. Ifyour project does not meet the guidelines listed below, you will need to request permission to share materials which contain the PCS.

PCS purchased by a school:I

If a copy of a PCS book or software is purchased for a school, teachers or therapists in the school may use the PCS in materials for the students in the school. Copying the materials for an entire school system is illegal.

I PCS purchased by a teacher or therapist:

I Ifa copy of a PCS book or software is purchased by a therapist or teacher, the therapist or teacher may use the PCS materials with persons in his/her caseload. This also means that an itinerant teacher or

I therapist may use the materials for students in multiple schools if the students using the materials are in Ihis/her caseload. Copying the materials for an entire school system is illegal. I'

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If a copy of a PCS book or software is purchased for a hospital, therapists in the hospital may use the PCS materials with the patients of the hospital. Copying the materials for an entire hospital system is illegal.

For all other uses:'

For uses that do not conform to the copyright guidelines above, you will need to request permission to use the PCS. Please fill out the P(S Pcrmis-.ion Request Forn1, and we wi ll contact you as soon aspossible to discuss your project. I

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Permission to use the PCS is frequently granted for the following uses:

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Using the PCS in commercial products:

We commonly grant permission or enter into licensing agreements for the right to use the PCS in books and materials printed by authors or published and sold by other companies. Contact our office for more information.

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newsletters

- charity fund raising materials (T-shirts, calendars, greeting cards, etc)- decorative web site graphics- workshop handouts- sales samples for devices or other communication products- handouts for teacher education- books on how to teach special needs students- books supplied to non-readers with information on rights and services

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Mayer-Johnson, lnc. (800) 588-4548 9/4/03 3:06 PM

If you recei ve permission to use the PCS with your project, we require that you include this copyright statement on your project:

The Picture Communication Symbols copyright ' 1981-2003 Mayer-Johnson, Inc. Used with permission.

To help us publicize our products, we woul d appreciate it if you include our company i nformation in the resource section of your documentation. It is as follows:

Mayer-Johnson, Inc.P.O. Box 1579

Solana Beach, CA 92075U.S.A.

Phone: 858 550-0084Fax: 858 550-0449

email: [email protected] site: www.mayer-johnson. com

Thank you,

Mayer-Johnson, Inc

Copyright ' 2003 Mayer-Johnson, Inc. All Rights Reserved.Conunents or Questions

Page update 7-14-03

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Documents

kccsteachersandstaff.weebly.com · Web view9/03 The Picture Communication Symbols (PCS) copyright ©1981-2003 Mayer-Johnson, Inc. Used with permission. 9/03 The Picture Communication