Behavioral Analysis Chart Incident No

Analysis

Behavioral Analysis Chart Incident No.:

1.  Identify the physical behavior in question in the second column, for example, used a table saw without a blade guard. (If more than one behavior, analyze each separately on a separate sheet.)

2.  List what factors “triggered” the behavior in the first column.

3.  List what consequences followed the behavior in the third column.

4.  Evaluate each consequence in the fourth column.

a.  “+” for a positive outcome or “-“ for a negative outcome.

b.  “S” for a consequence that will more than likely occur sooner, or “L” for a consequence that will more than likely occur later.

c.  “C” for a consequence that is certain to occur, or “U” for a consequence that in uncertain to occur.

Triggers (2) / Behavior (1) / Consequences (3) / Evaluation (4)
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