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Self-Monitoring Behavior Form Template

Enhance Your Self-Reflection with This Practical Template

You may struggle to gain clarity on your habits and behaviors, making personal growth a challenge. This self-monitoring behavior form template is designed for individuals looking to track and evaluate their actions consistently, leading to better self-awareness and improvement. Use it to identify patterns, set specific goals, and reflect on your daily experiences, allowing you to take actionable steps toward positive change. Experience the benefits of improved focus and accountability-try the live template today.

Date of entry
Which behavior are you monitoring today?
Did the behavior occur since your last entry?
Yes
No
Where did it occur?
Home
Work
School
Public place
In transit
Online/digital
Not applicable
Other
Please Specify:
Who was present?
Alone
Family/partner
Friends
Coworkers/classmates
Supervisor/teacher
Strangers
Not applicable
What triggered the behavior?
Please Specify:
Approximate time of occurrence
How were you feeling just before?
Very unhappy
Unhappy
Neutral
Happy
Very happy
Not applicable
How many times did the behavior occur?
About how long did it last in total?
How strong was your urge?
None
Mild
Moderate
Strong
Very strong
Not applicable
What happened right after?
Please Specify:
Did you meet your behavior goal for today?
Yes
Partially
No
No goal set
How difficult was it to stick to your plan today?
Very difficult
Difficult
Neutral
Easy
Very easy
Not applicable
Which strategies did you use?
Please Specify:
What is your plan for next time?
How likely are you to follow this plan next time?
Very unlikely
Unlikely
Neutral
Likely
Very likely
Not applicable
Any notes or observations?
Overall, how satisfied are you with your progress today?
Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied
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Paper art illustration depicting a self-monitoring behavior form for FormCreatorAI article

When to use this form

Use this form when a student is working on replacing a target behavior (for example, calling out, off-task, or leaving seat) with a positive choice. Teachers, aides, counselors, and students can use it daily or weekly to note triggers, strategies, and outcomes. It works well alongside the Behavior observation form to align notes with objective data. After a fight or safety issue, pair it with the Student incident report form for a full record. If a substitute covers the class, the Substitute teacher reporting form helps maintain continuity of supports. Consistent use highlights patterns, informs IEP or BIP meetings, and shows growth the student can see.

Must Ask Self-Monitoring Behavior Questions

  1. What specific behavior are you tracking today? Define it in observable terms.

    Clear, observable definitions reduce confusion and improve consistency across staff. They also help the student know exactly what to notice and record.

  2. When and where did it happen? Note the time, setting, and who was present.

    Times, places, and people reveal triggers and setting events. With this pattern, you can adjust schedule, seating, or demands to prevent problems.

  3. How often and how strong was it? Record frequency, duration, or intensity (1-5).

    Numbers show progress and help you evaluate whether supports are working. Frequency, duration, or a 1-5 intensity rating makes trends easy to share with families and teams.

  4. Which strategies or supports did you use, and how effective were they?

    Linking strategies to results shows what works and what to change next. You can summarize effective supports over a term in the Secondary school report form.

  5. How does the student rate their behavior today, and what are the next steps or referrals?

    Self-ratings build ownership, and written next steps make accountability clear. If behavior needs administrative action, you can record it with the Discipline referral form.

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