DAILY BEHAVIOR
SELF MONITORING SYSTEM
The below form is a sample form from a parent. This form has been
used with her son and he has done quite well using it. On the
form below there is a chart with eight periods where the teachers
initial if the child meets his targets for that period. You
are welcome to use
this form as a guide when assisting your son.
Periods 1
2 3 4
5 6 7 8
Teacher's
initials ______
Date:________________ Name:__________________
Targets:
I asked for
help.
I used self control.
I tried when it was hard.
I used positive body language.
______________________
________________________
Student signature
Teacher signature
Three positive things about my day.
1.__________________________________________________________________
2.__________________________________________________________________
3.__________________________________________________________________
Today I made __________(good/poor) choices. Tomorrow I am going to
___________
____________________________________________________________________
When I make good choices I ___________________________________(how I
feel)
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Last updated on March 9, 2008