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Onekama
Consolidated School
Responsible Thinking Center (RTC) Form
Name: _____________________________ Date/Time:
_______________
Staff: _____________________________ Grade: K 1 2 3
4 5
Location:
Playground Media Center Cafeteria Bus Hallway
Classroom Arrival/Dismissal
Bathroom Other:
______________________
|
Minor Problem
Behavior |
Major Problem
Behavior |
Possible Motivation |
|
__ Inappropriate
Language
__ Physical Contact
__ Defiance
__ Disruption
__ Dress Code
__ Property Misuse
__ Tardy
__ Electronic Violation
__ Out of seat
__ Not following
directions
__ Cheating
__ Teasing
__ Running in the
Hallway
__ Other |
__ Inappropriate
Language
__ Fighting/Physical
Aggression
__ Defiance/Disrespect
__ Harassment/Bullying
__ Inappropriate
Display
__ Electronic Violation
__ Lying/Cheating
__ Throwing
Rocks/Snowballs
__ Other |
__ Obtain peer
attention
__ Obtain adult
attention
__ Obtain
items/activities
__ Avoid Peer(s)
__ Avoid Adult
__ Avoid task or
activity
__ Don’t know
__ Other |
Others involved in Incident: __ None __Peers __ Staff __
Teacher __Substitute
__ Unknown __ Other
Other Comments: _____________________________________________________
___________________________________________________________________
___________________________________________________________________
|
Administrative Decision |
|
__ Loss of Privilege
__ Time in RTC/Office
__ Conference with
Student
__ Parent Contact |
__ Individualized
Instruction
__ In-School Suspension
(___ hours/days)
__ Out of School
Suspension (__days)
__ Other |
All minors are filed with RTC Coordinator. Three minors equal a major.
All majors require administrator consequence and parent contact. |