PBIS Self-Assessment Survey (SAS) 
Assessing and Planning Behavior Support in Schools
Version 3.0 
August 2009

Purpose of the Survey

The PBIS Self-Assessment Survey (SAS) is used by school staff for initial and annual assessment of effective behavior support systems in their school. The survey examines the status and need for improvement of four behavior support systems: (a) school-wide discipline systems, (b) non-classroom management systems (e.g., cafeteria, hallway, playground, (c) classroom management systems, and (d) systems for individual students engaging in chronic problem behaviors. Each question in the survey relates to one of the four systems.

Survey results are summarized and used for a variety of purposes including:

1.	annual action planning,
2.	internal decision making,
3.	assessment of change over time,
4.	awareness building of staff, and
5.	team validation.

The survey summary is used to develop an action plan for implementing and sustaining effective behavioral support systems throughout the school (see “Developing a PBIS Annual Action Plan”).

Conducting the SAS

Who completes the survey?

Initially, the entire staff in a school completes the SAS.  In subsequent years and as an on-going assessment and planning tool, the SAS can be completed in several ways:

•	All staff at a staff meeting. 
•	Individuals from a representative group.
•	Team member-led focus group.

When and how often should the survey be completed?

Since survey results are used for decision making and designing an annual action plan in the area for effective behavior support, most schools have staff complete the survey at the end or the beginning of the school year.

How is the survey completed?

1.	Complete the survey independently. 

2.	Schedule 20-30 minutes to complete the survey.

3.	Base your rating on your individual experiences in the school. If you do not work in classrooms, answer questions that are applicable to you.

4.	Mark (i.e., “” or “X”) on the left side of the page for current status and the right side of the page for the priority level for improvement for each feature that is rated as partially in place or not in place and rate the degree to which improvements are needed (i.e., high, medium, low) (right hand side of survey). 

5.	To assess behavior support, first evaluate the status of each system feature (i.e. in place, partially in place, not in place) (left hand side of survey). Next, examine each feature:

a.	“What is the current status of this feature (i.e. in place, partially in place, not in place)?” 

b.	For each feature rated partially in place or not in place, “What is the priority for improvement for this feature (i.e., high, medium, low)?” 

Summarizing the Results from the SAS

	The results from the SAS are used to (a) determine the status of PBIS in a school and (b) guide the development of an action plan for improving PBIS. The resulting action plan can be developed to focus on any one or combination of the four PBIS system areas. 

Three basic phases are involved: (a) summarize the results, (b) analyze and prioritize the results, and (c) develop the action plan.

Phase 1: Summarize the results

	The objective of this phase is to produce a display that summarizes the overall response of school staff for each system on (a) status of PBIS features and (b) improvement priorities.

Step 1a. Summarize survey results on a blank survey by tallying all individual responses for each of the possible six choices as illustrated in example 1a.

Example 1a.

Current Status	
Feature	
Priority for Improvement 	

In Place	
Partial in
Place	
Not in Place	
School-wide is defined as involving all students, all staff, & all settings.	
High	
Med	
Low	

	
	
1. A small number (e.g. 3-5) of positively & clearly stated student expectations or rules are defined. 	

	

	
	
2. Expected student behaviors are taught directly.	

	

Step 1b. Total the number of responses by all staff for each of the six possible choices. As illustrated in example 1b.

Example 1b.

Current Status	
Feature	
Priority for Improvement 	

In Place	
Partial in
Place	
Not in Place	
School-wide is defined as involving all students, all staff, & all settings.	
High	
Med	
Low	

9	
7	
4	
1. A small number (e.g. 3-5) of positively & clearly stated student expectations or rules are defined. 	
4	
4	
3	

2	
6	
12	
2. Expected student behaviors are taught directly.	
10	
4	
6	

7
	
9	
3	
3. Expected student behaviors are rewarded regularly.	
6	
6		

7	
11	
3	
4. Problem behaviors (failure to meet expected student behaviors) are defined clearly.	
6	
4	
4	
	
8
	
9	
5. Consequences for problem behaviors are defined clearly.	
11	
3	
3	

Step 1c. For each system area, calculate a total summary by counting the total number of responses for a column (e.g., In place: 9 + 2 + …..) and dividing that number by the total number of responses for the row (e.g., In place + Partial + Not in place) as illustrated in example 1c.  

Example 1c.

Current Status	
Feature	
Priority for Improvement 	

In Place	
Partial in
Place	
Not in Place	
School-wide is defined as involving all students, all staff, & all settings.	
High	
Med	
Low	

9	
7	
4	
1. A small number (e.g. 3-5) of positively & clearly stated student expectations or rules are defined. 	
4	
4	
3	

2	
6	
12	
2. Expected student behaviors are taught directly.	
10	
4	
6	

7
	
9	
3	
3. Expected student behaviors are rewarded regularly.	
6	
6		

7	
11	
3	
4. Problem behaviors (failure to meet expected student behaviors) are defined clearly.	
6	
4	
4

8
	
9	
5. Consequences for problem behaviors are defined clearly.	
11	
3	
3
	
Totals
     25      +        41      +      31=   97						        37    +      21      +  16  = 74

Step 1d. Create a bar graph showing total item summary percentages for each of the six choices (take total responses for each of six choices and divide by the total number of responses) as illustrated in example 1d. using results from example 1c.. Complete the SAS Summary by graphing the current status and priority for improvement for each of the four system areas.  Example 1d. has created the graph for the example data presented and summarized in example 1c. 

Example 1d.

 
Completing Phase 1 provides a general summary for the current status and priority for improvement ratings for each of the four system areas. For further summary and analysis, follow Phase 2 and Phase 3 activities. 

Phase 2: Analyze and Prioritize the Results

The objective of this phase is for teams to narrow the focus of Action Plan activities. Teams also may want to include other data or information (e.g., office discipline referrals, behavior incident reports, attendance) to refine their decisions. Use the SAS Summary to guide and document your analysis. In general, the following guidelines should be considered:

Step 1.  Using the SAS Summary Graph results, rate the overall perspective of PBIS implementation by circling High, Med., or Low for each of the four system areas.

Step 2.  Using the SAS Tally pages, list the three major strengths in each of the four system areas.

Step 3. Using the SAS Tally pages, list the three major areas in need of development.

Step 4. For each system, circle one priority area for focusing development activities. 

Step 5. Circle or define the activities for this/next year’s focus to support the area selected for development

Step 6. Specify system(s) to sustain (S) & develop (D).

Phase 3: Use the SAS Summary Information to Develop 
the PBIS Annual Action Plan

The objective of this phase to develop an action plan for meeting the school improvement goal in the area of school safety.  Multiple data sources will be integrated when developing the action plan.  The SAS Summary page summarizes the SAS information and will be a useful tool when developing the PBIS Annual Action Plan. The PBIS Annual Action Plan process can be obtained by contacting the first author of this document.

 (PBIS) Self Assessment Survey
Assessing and Planning Behavior Support in Schools

Name of school							 Date 
District								 State 

Person Completing the Survey:

 Administrator			 Special Educator		 Parent/Family member
 General Educator			 Counselor			 School Psychologist
 Educational/Teacher Assistant	 Community member	 Other 

1.	Complete the survey independently. 

2.	Schedule 20-30 minutes to complete the survey.

3.	Base your rating on your individual experiences in the school. If you do not work in classrooms, answer questions that are applicable to you.

To assess behavior support, first evaluate the status of each system feature (i.e. in place, partially in place, not in place) (left hand side of survey). Next, examine each feature:

a.	“What is the current status of this feature (i.e. in place, partially in place, not in place)?” 

b.	For those features rated as partially in place or not in place, “What is the priority for improvement for this feature (i.e., high, medium, low)?” 

4.	Return your completed survey to 						 by		        .

SCHOOL-WIDE SYSTEMS

Current Status	
Feature	
Priority for Improvement 	

In Place	
Partial in 
Place	
Not in Place	
School-wide is defined as involving all students, all staff, & all settings.	
High	
Med	
Low	

	
	
1. A small number (e.g. 3-5) of positively & clearly stated student expectations or rules are defined. 	

	

	
	
2. Expected student behaviors are taught directly.	

	

	
	
3. Expected student behaviors are rewarded regularly.	

	

	
	
4. Problem behaviors (failure to meet expected student behaviors) are defined clearly.	

	

	
	
5. Consequences for problem behaviors are defined clearly.	

	

	
	
6. Distinctions between office v. classroom managed problem behaviors are clear.	

	

	
	
7. Options exist to allow classroom instruction to continue when problem behavior occurs. 	

	

	
	
8.Procedures are in place to address emergency/dangerous situations.	

	

	
	
9. A team exists for behavior support planning & problem solving.	

	

	
	
10. School administrator is an active participant on the behavior support team.	

	

	
	
11. Data on problem behavior patterns are collected and summarized within an on-going system.	

	

	
	
12. Patterns of student problem behavior are reported to teams and faculty for active decision-making on a regular basis (e.g. monthly).	

	

	
	
13. School has formal strategies for informing families about expected student behaviors at school.	

	

	
	
14. Booster training activities for students are developed, modified, & conducted based on school data.	

	

	
	
15. School-wide behavior support team has a budget for (a) teaching students, (b) on-going rewards, and (c) annual staff planning.	

	

	
	
16. All staff are involved directly and/or indirectly in school-wide interventions.	

	

	
	
17. The school team has access to on-going training and support from district personnel.	

	

	
	
18. The school is required by the district to report on the social climate, discipline level or student behavior at least annually.	

	

Name of School ____________________________________________			Date ______________

NONCLASSROOM SETTING SYSTEMS

Current Status	
Feature	
Priority for Improvement 	

In Place	
Partial in Place	
Not in Place	
Non-classroom settings are defined as particular times or places where supervision is emphasized (e.g., hallways, cafeteria, playground, bus).	
High	
Med 	
Low	

	
	
1. School-wide expected student behaviors apply to non-classroom settings.	

	

		
2. School-wide expected student behaviors are taught in non-classroom settings.	

	

	
	
3. Supervisors actively supervise (move, scan, & interact) students in non-classroom settings.	

	

	
	
4. Rewards exist for meeting expected student behaviors in non-classroom settings.	

	

	
	
5. Physical/architectural features are modified to limit (a) unsupervised settings, (b) unclear traffic patterns, and (c) inappropriate access to & exit from school grounds.	

	

	
	
6. Scheduling of student movement ensures appropriate numbers of students in non-classroom spaces.	

	

	
	
7. Staff receives regular opportunities for developing and improving active supervision skills.	

	

	
	
8.  Status of student behavior and management practices are evaluated quarterly from data.	

	

	
	
9. All staff are involved directly or indirectly in management of non-classroom settings.	

	

Name of School ____________________________________________			Date ______________

CLASSROOM SYSTEMS

Current Status	
Feature	
Priority for Improvement 	

In Place	
Partial in Place	
Not in Place	
Classroom settings are defined as instructional settings in which teacher(s) supervise & teach groups of students.	
High	
Med 	
Low	

	
	
1. Expected student behavior & routines in classrooms are stated positively & defined clearly. 	

	

	
	
2. Problem behaviors are defined clearly.	

	

	
	
3. Expected student behavior & routines in classrooms are taught directly.	

	

	
	
4. Expected student behaviors are acknowledged regularly (positively reinforced) (>4 positives to 1 negative). 	

	

	
	
5. Problem behaviors receive consistent consequences.	

	

	
	
6. Procedures for expected & problem behaviors are consistent with school-wide procedures.	

	

	
	
7. Classroom-based options exist to allow classroom instruction to continue when problem behavior occurs. 	

	

	
	
8. Instruction & curriculum materials are matched to student ability (math, reading, language).	

	

	
	
9. Students experience high rates of academic success (> 75% correct).	

	

	
	
10. Teachers have regular opportunities for access to assistance & recommendations (observation, instruction, & coaching).	

	

	
	
11. Transitions between instructional & non-instructional activities are efficient & orderly.	

	

Name of School ____________________________________________			Date ______________

INDIVIDUAL STUDENT SYSTEMS

Current Status	
Feature	
Priority for Improvement 	

In Place	
Partial in Place	
Not in Place	
Individual student systems are defined as specific supports for students who engage in chronic problem behaviors (1%-7% of enrollment)	
High	
Med 	
Low	

	
	
1. Assessments are conducted regularly to identify students with chronic problem behaviors.	

	

	
	
2. A simple process exists for teachers to request assistance.	

	

	
	
3. A behavior support team responds promptly (within 2 working days) to students who present chronic problem behaviors.	

	

	
	
4. Behavioral support team includes an individual skilled at conducting functional behavioral assessment.	

	

	
	
5. Local resources are used to conduct functional assessment-based behavior support planning (~10 hrs/week/student). 	

	

	
	
6. Significant family &/or community members are involved when appropriate & possible.	

	

	
	
7. School includes formal opportunities for families to receive training on behavioral support/positive parenting strategies.	

	

	
	
8. Behavior is monitored & feedback provided regularly to the behavior support team & relevant staff.	

	

Name of School ____________________________________________			Date _____________
SAS Summary Graph
School: ___________________________                           Date: __________
	Current Status	
100		

90		

80		

% of  total responses

70		

60		

50		

40		

30		

20		

10		

0		
	In  place    partial    not 	In place   partial    not	        In place     partial      not           In  place    partial    not
                  School wide Systems 	Non-classroom Systems	          Classroom  Systems            Individual Student Systems
	Priority for Improvement	
100		

90		

80		

% of total responses

70		

60		

50		

40		

30		

20		

10		

0		
	High   Med       Low 		High        Med       Low	High     Med     Low  	High          Med         Low
               School wide Systems 	Non-classroom Systems	Classroom  Systems	Individual Student Systems

SAS Summary
School: ______________________________________________ 								Date: _________________

Use the SAS Tally page and the SAS Summary Graph to develop an accurate summary & determine initial focus area priorities
For each system area, follow the steps as outlined below	Overall Perception	
	School-wide	Non-classroom	Classroom	Individual Student	
1. Use SAS Summary Graph to rate overall perspective of PBIS implementation & circle High, Med. or Low	High
Med
Low	High
Med
Low	High
Med
Low	High
Med
Low	
2. Using SAS Tally Pages, list three major strengths 	
a.

b.

c.
	
a.

b.

c.
	
a.

b.

c.
	
a.

b.

c.
	
3. Using the SAS Tally pages, list three major areas in need of development.

4. For each system, circle one priority area for focusing development activities	
a

b.

c.
	
a.

b

c
	
a.

b.

c.
	Targeted group or
Individual interventions
a.

b.

c.
	
5. Circle or define activities for this/next year’s focus to support area selected for development	a. Organize a team
b. Define/teach school rules
c. Define consequence systems for appropriate & inappropriate behavior
d. Define a measurement system linked to school improvement goal
e. Establish communication cycles with other school teams
f. Develop implementation plan	a. Define/teach routines
b. Supervisor booster training & feedback sessions
c. Data management
d. Maintain team & communication cycle with other school teams
e. Develop implementation plan
	a. Define/teach routines/ link with school wide rules
b. Classroom staff boosters & feedback sessions for creating effective strategies/materials
c. Data management
d. Maintain team & communication cycle with other school teams
e. Develop implementation plan	a. Process for referral & support plan design, implementation & monitoring
b. Plan to develop & use FBA to support skills
c. Data management
d. Maintain team & communication cycle with other school teams
e. Develop implementation plan	
6. Specify system(s) to: sustain (S) & develop (D).					
7. Use the PBIS Annual Action Planning form for determining management, design & implementation activities in the selected focus areas.