1. Teacher Box
  2. [mascot] Problem Solver
    1. Your Mascot Image Here
  3. Name:
  4. What happened?
  5. My actions bothered/hurt: (circle)
  6. How are you going to fix it?
  7. I am ready to Be A Learner! Yes No


Teacher Box


 
Date:  Time:  


 

 


 

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[mascot] Problem Solver

 

 


 

 





Your Mascot Image Here

 

 


 

 

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Name:

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What happened?
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 My Brain said: 		My Body did:


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Now! My heart feels:  


 

 

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My actions bothered/hurt: (circle)
Myself
 
My Classmates
 
An Adult
School Property
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How are you going to fix it?
Apology
 
Clean up
 
Refocus Break
 
Other
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I am ready to Be A Learner! Yes No

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