Behavioral Data

Name: Logan Florea Today’s Date: __________________

Date of Birth: 08/12/2010 Su M T W Th F Sa
LTT Essential Demand
AGG DIS ISB ( begins after SLEEP Staff
Time “more time” break Completed Initial
period)
s
Frequency Frequency Frequency Duration Duration

12:00-12:30am : Y / N AA
12:30-1:00am : Y / N
1:00-1:30am : Y / N
1:30-2:00am : Y / N
2:00-2:30am : Y / N
2:30-3:00am : Y / N *Please circle what
3:00-3:30am : Y / N essential demands are
3:30-4:00am Y / N completed throughout the
4:00-4:30am : Y / N day*
4:30-5:00am : Y / N
5:00-5:30am : Y / N
5:30-6:00am : Y / N
6:00-6:30am 0 0 0 :0 Y / N
6:30-7:00am : Y / N AA
7:00-7:30am : Y / N Showered AA
7:30-8:00am : Y / N AA
8:00-8:30am |||| |||| |||| || : Y / N Teeth Brushed AA
8:30-9:00am : Y / N AA
Y / N AA
9:00-9:30am : Hands Washed
9:30-10:00am : Y / N AA
10:00-10:30am : Y / N AA
Hair Washed
10:30-11:00am |||| : Y / N AA
11:00-11:30am : Y / N AA
11:30-12:00pm : Y / N AA
12:00-12:30pm : Y / N AA
12:30-1:00pm : Y / N AA
1:00-1:30pm : Y / N AA
1:30-2:00pm : Y / N AA
2:00-2:30pm : Y / N AA
2:30-3:00pm : Y / N AA
3:00-3:30pm : Y / N
3:30-4:00pm : Y / N
4:00-4:30pm 5 3 9 : 30 Y / N
4:30-5:00pm 2 2 4 1 : 10 Y / N
5:00-5:30pm : Y / N
Y / N
Showered
5:30-6:00pm :
6:00-6:30pm : Y / N
6:30-7:00pm : Y / N
Teeth Brushed
7:00-7:30pm : Y / N
Hands Washed

TLOA
7:30-8:00pm : Y / N
8:00-8:30pm : Y / N
8:30-9:00pm : Y / N Hair Washed
9:00-9:30pm : Y / N
9:30-10:00pm : Y / N
10:00-10:30pm : Y / N
10:30-11:00pm : Y / N
11:00-11:30pm : Y / N
11:30-12:00am : Y / N
Daily Totals

Shift Staff Name Initials Staff Name Initials

11p-7a Adams Apple AA
7a-3p
3p-11p

Additional Tips
 TLOA = “temporary leave of absence”. Staff will write TLOA in the intervals that IWS is not staffed by
Bancroft (e.g. home with family). If staffed by another Bancroft staff but IWS was not in unit, ask for data
from that staff.

 Sleep = staff will draw a single line through each and every interval that IWS is asleep.

 Freq = Frequency. Record a tally mark in the corresponding column for each behavior seen then record the
total # of tally marks, write total # and circle it (e.g. llll 4) (every 4 tallies, the 5 th tally is crossed through
ex. | | | | )

 Staff Initials = Staff working with IWS will record their initials in each interval. Staff will also print, initial,
and record their hours staffed in the rows below.

 Overnight: Overnight should be putting the date and day on each data sheet when switching out to new
sheets. Also, old data should be put into the “completed data” binder per unit in each IWS’s selected spots.
Make sure to fill in the last two intervals (11:00pm-12:00pm) before placing into binder.

 On the back of every data sheet, there is a breakdown definition for every tracked behavior. Please utilize
when filling in data sheets to ensure to the most accurate data input.

 If anyone is on a rotation, please make sure to input data for the time of your rotation.