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Functional Assessment Checklist for Teachers and Staff (FACTS-Part A)
Step 1
Step 2
Step 3
Step 4
Step 5
Student/ Grade: ______________________________ Date: ____________________________
Interviewer: _________________________________ Respondent(s): ____________________
Student Profile: Please identify at least three strengths or contributions the student brings to school.
______________________________________________________________________________________
Problem Behavior(s): Identify problem behaviors
___ Tardy ___ Fight/physical Aggression ___ Disruptive ___ Theft
___ Unresponsive ___ Inappropriate Language ___ Insubordination ___ Vandalism
___ Withdrawn ___ Verbal Harassment ___ Work not done ___ Other ________________
___ Verbally Inappropriate ___ Self-injury
Describe problem behavior: ____________________________________________________________
Identifying Routines: Where, When and With Whom Problem Behaviors are Most Likely.
Schedule
(Times)
Activity Likelihood of Problem Behavior Specific Problem Behavior
Before School Low High
1 2 3 4 5 6
Math
1 2 3 4 5 6
Transition
1 2 3 4 5 6
Language Arts
1 2 3 4 5 6
Recess
1 2 3 4 5 6
Reading
1 2 3 4 5 6
Lunch
1 2 3 4 5 6
Science
1 2 3 4 5 6
Transition
1 2 3 4 5 6
Block Studies
1 2 3 4 5 6
Art
1 2 3 4 5 6
Select 1-3 Routines for further assessment: Select routines based on (a) similarity of activities
(conditions) with ratings of 4, 5 or 6 and (b) similarity of problem behavior(s). Complete the FACTS-
Part B for each routine identified.
March, Horner, Lewis-Palmer, Brown, Crone, Todd & Carr (2000) 4/24/00
source: doe.virginia.gov
