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Solve It Sheet

By Charlotte Morgan,2014-11-13 17:06
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Solve It Sheet

    Solve It Sheet

Student: _______________________________________ Date: _____________

    Teacher: _______________________________________ Date of Incident: _____________

    I understand this “Solve It Sheet” is intended to help me think about what has happened and to give me the opportunity to tell why it happened. It will also help me solve the problem so that I

    can better understand myself and others. I accept the consequences of my behavior and want to

    do things differently in the future.

Where were you? Classroom Hallway Bathroom

     Cafeteria Office Bus

     Other:__________________________________

What happened? Not following directions

     Argument with another student

     Argument with an adult

     Not completing work

     Taking something without permission

     Not being where I was assigned

     Teasing someone

     Someone teasing me

     Not liking what was happening at the moment

     Getting into a physical confrontation with someone (e.g., fighting)

     Other:________________________________________________

Who was involved? Another student

     A teacher

     A substitute teacher

     A principal/assistant principal

     A teacher assistant

     A bus driver

     Cafeteria worker

     Custodian

     Another adult in school: __________________________________

     Other:_________________________________________________

What did you do?

     Ignored what was happening Did it back to the person

     Yelled at/Threatened someone Asked for help

     Cursed/used bad language Moved away from the person

     Started or responded to a fight Asked the person to stop

     Made a bad choice Lied about what happened/what I did

     Admitted what I did

     Other:_________________________________________________

How did you feel when it happened?

     Was ticked off Embarrassed

     Sad Confused

     Hurt/Disappointed Uncomfortable

     Cheated Jealous

     Bothered Annoyed

     Fine/didn’t really bother me Pressured

     Dumb Nervous

     Scared Very angry

     Other:_________________________________________________

Now that it is over, I feel…

     Pretty bad Pretty good

     Awful Okay

     Not so hot Embarrassed

     Good Wasn’t treated fairly

     Other:_________________________________________________

A better choice would have been to…

     Walk away Ask for help

     Ignore Talk it out

     Answer respectfully Move away

     Follow direction Use a better tone of voice

     Raise my hand Keep my body to myself

     Think before I act Be respectful

     Go to a friend for advice Go to an adult for advice

     Other:_________________________________________________

What I am going to do now to make it OK….

     Apologize appropriately to all involved

     Talk with the person appropriately and respectfully

     Make restitution

     Go back to class and try again appropriately

     Tell myself to be positive

     Use self-talk to work out a solution before I act

     Other:_________________________________________________

Signature of Student: __________________________________________ Date: ___________

Signature of Teacher: __________________________________________ Date: ___________

Signature of Parent: ____________________________________________Date: ___________

    (If appropriate)

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