Functional Behavior Assessment (FBA) Template
Student Information
Name
Date of Birth
School/Grade
Assessment Date
Assessor(s)
Referral Information
Reason for Referral
Target Behavior(s)
Problem Behavior(s) Description
Behavioral Definitions
Behavior
Frequency
Duration
Intensity
Antecedents
Events Before Behavior
Setting Events
Consequences
Events After Behavior
Function of the Behavior
Hypothesized Function(s)
Summary/Recommendations
Summary
Recommendations