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Xes across the corresponding row to indicate which behaviors, antecedents, and consequences were observed. After all observations are completed, create a summary statements that describes the antecedents and consequences that are most closely related to each behavior and build an intervention plan using this summary. A template for writing summary statements can be found on page 2 of this form. Adapted with permission from the Functional Assessment Observation Form (O’Neill, Horner, Albin, Spr.

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