BASIS Tracking Logs

The following downloadable files are examples designed by the Cottonwood CDDO for use in tracking behaviors and seizures to serve as documentation for the BASIS Assessment. In order to capture behaviors in the BASIS assessment there must be documented proof of their occurrence.  These forms or something similar should be used to document behaviors in all settings (Home, Community, School, Day services, Job, etc.)  

NOTE: Behavior Tracking is not necessary for individuals with a Tier 1-5, who are also not currently receiving HCBS funded Day, Residential or In-Home Supports. An annual BASIS re-evaluation will not be completed on these individuals until funding is offered. If you have any questions about whether or not you should be tracking behaviors contact your Case Manager or the CDDO.

Behavior Tracking Logs

12 Page versionPDF / ExcelOne page per month, provides a month-at-a-glance view
4 Page versionPDF / Excel2 pages front & back that provides a Year-at-a-glance view
2 Page versionPDF / ExcelVery compact 1 page front & back version, year-at-a-glance view
Large Print versionPDFHalf a month per page, large print version
Fax versionPDF / ExcelPrintable PDF file designed to be easier to read for faxing purposes
Versión EspañolaPDFRegistro del comportamiento en español
Behavior definitionsPDFDescriptions of each behavior for the purposes of the BASIS

Seizure Tracking Log

1 Page version PDF / ExcelOne page per year, seizure frequency tracking for BASIS Assessment