Blue Card

Digital Blue Card

Student Name: Grade: Pre-K Kindergarten First Second Third Fourth Fifth Sixth Seventh Eighth Highschool Teacher Name: Time: Date: Behavior (Select multiple): Noncompliance Verbal Defiance Tantrum Property Destruction Physical Aggression Elopement SIB (Self-Injurious Behavior) Activity (Select multiple): Asked to do something Bothered by peer Could not get desired item/activity Activity interrupted Low/No activity Attention from staff Possible Function (Select multiple): Get Staff Attention Get Peer Attention Remove Attention Get Object/Activity Self-Stimulation Avoid Activity/Demand Other Location: Bathroom Classroom Hallway Music Gym Art Bus Loading Zone Consequence (Select multiple): Verbal Redirect Ignored Provided Attention Blocked Chair Time-Out RTO Separation Restraint

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