Papago School-Pyramid of Intervention Student Log
Please fill out the student fields completely and give as much detail as possible concerning the infraction. If possible, notify the homeroom teacher of the infraction.
1. Student Name
2. Student ID
3. Reporting Teacher
4. Date (00/00/00)
5. Offense/Code
1-mocking
2-retorts
3-argumentative
4-putdowns
5-inappropriate language
6-talking
7-throwing
8-out of seat
9-tardy
10-noises
11-NFD
12-gum
13-dress code
14-no HW
15-incomplete
16-pushing
17-playground
18-cheating or forgery
19-vandalism
20-petty theft
6. Action Taken
1st warning
2nd warning
3rd warning
time out
loss of privilege
behavior reflection log
write a letter
lunch detention
after-school detention
campus clean up
buddy classroom
one-on-one conference
student calls parent
teacher calls parent
other
7. Parent Contact
No
Yes
8. Comments
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