Student Reflection on Incident Form Based on Restorative Practices
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This bundle is a set of 6 class forms designed for upper middle school and high school teachers. This bundle features all products in my Class Documents line of resources, which consists of materials that I use on a daily basis in my classroom to help students understand my expectations and to simpPrice $6.00Original Price $7.50Save $1.50
This is a custom bundle created for Suzanne. It is a collection of various class forms and resources, nature of science and chemistry products. Bundle Contents:NGSS Middle School Chemistry Curriculum - Full Course BundleSuper Bundle – Scientific Method & MetricsBundle - Class Forms, Notices, andPrice $258.02Original Price $368.10Save $110.08
Description
This 1-page Student Reflection Form template product is designed for upper middle school and high school teachers. The form features 5 questions that allow students to reflect on their actions, imagine how it affected others, create a plan to make it right and prevent it from recurring, and list individuals who may be able to help with their plan (if needed). The form was created to utilize the restorative practices approach to addressing student behavior, which fosters belonging over inclusion, student engagement over control, and meaningful accountability over punishment.
Reflection Form Sections/Questions:
- Basic student information (name, class, date)
- Describe what happened. What are your thoughts on the incident?
- Who was affected by your actions? How might they feel?
- How can you make it right with them?
- What actions will you take to prevent this from happening again?
- Who can help you with this? What can they do?
- Signature section: (A) student; (B) parent; (C) teacher
Philosophy/How I Use This Product:
If a student is not exhibiting appropriate behavior or choices in class, I give a non-verbal cue for them to stop and redirect their focus. If they continue, I issue a clear and specific warning to halt the behavior or they will be sent out of the classroom. If the behavior (or similar) occurs a third time, the student is sent into the hallway for a short time (3 - 5 minutes) to "cool off", which gives them a chance to think about their actions. I always want the student to return to class so as to not miss instruction.
When I meet with the student in the hallway, we discuss expectations of behavior in my class and how they may improve the situation. I inform them they will be expected to attend an after school meeting (I use the Detention Form to make it officially known to parents) so that we may discuss the matter in an environment separate from their peers. After being let back into the room, the student may return to their own seat or another location, depending on the nature of the behavior.
During the after school meeting (30 minutes), I hand them the Reflection Form and give them time to complete it. Then we discuss their responses using the following approach:
Validate and Value
- I mention that I appreciate their willingness to discuss the situation.
Inquire About Next Steps
- I ask them what we both can do with the information they provided.
- If appropriate, I ask if there is something I can do to support them.
Follow Through
- If needed, I will contact the appropriate person (e.g. parent, counselor, etc.)
- I follow up with the student the next day, telling them it's a fresh start but also looking for opportunities for additional support.
Downloadable in 2 Formats:
- This product comes in a static PDF document and fully-editable Word document so teachers can modify the notice for their own needs.
- Feel free to download the full PDF preview to see EXACTLY what you are getting. No surprises!
Part of a Line of Class Resource Products:
This product is part of my new Class Documents line of resources, which consists of materials that I use on a daily basis in my classroom to help students understand my expectations and to simplify frequent tasks such as communicating missed homework assignments to parents, reporting detentions, and providing late slips. Links to these documents are found below.
You Might Also Like These Class Documents Products:
Form - Missing Homework Notice
Form - Behavior Tracking Sheet (Daily and Weekly)
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Terms of Use:
Copyright © Douglas Enns. All rights reserved by author. This product is to be used by the original downloader only. Copying for more than one teacher, classroom, department, school, or school system is prohibited. This product may not be distributed or displayed digitally for public view. Failure to comply is a copyright infringement and a violation of the Digital Millennium Copyright Act (DMCA). Clipart and elements found in this document are copyrighted and cannot be extracted and used outside of this file without permission or license. Intended for classroom and personal use ONLY.
