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Safe, Responsible & Respectful Check-In

Lesson Plan

Safe Responsible Respectful Check-In Lesson Plan

Students will learn to use the Daily Check-In Check-Out Form to self-monitor and reflect on the school’s three Be’s—Be Safe, Be Responsible, Be Respectful—fostering positive behavior and honest self-assessment.

Teaching daily self-monitoring builds student ownership of behavior, reinforces school expectations, and promotes consistent, positive choices throughout the day.

Audience

4th Grade Students

Time

10 minutes

Approach

Explicit teaching, modeling, and guided practice.

Materials

Whiteboard and Marker, Pencils for Students, Daily Check-In Check-Out Form, and Timer or Stopwatch

Prep

Teacher Preparation

5 minutes

  • Review the Daily Check-In Check-Out Form.
  • Print one form per student.
  • Write the headings “Be Safe,” “Be Responsible,” and “Be Respectful” on the whiteboard.
  • Set up a timer or stopwatch to keep the lesson on track.

Step 1

Engage and Introduce

2 minutes

  • Greet students and explain that today they’ll learn a new tool to track positive behaviors each day.
  • Ask students to briefly define what it means to be safe, responsible, and respectful in school.
  • Emphasize how these help everyone learn and feel welcome.

Step 2

Review the Three Be’s

2 minutes

  • Point to each heading on the whiteboard.
  • Read aloud “Be Safe,” “Be Responsible,” “Be Respectful” and give one concrete example of each (e.g., keeping hands to self).
  • Invite a volunteer to share their own example.

Step 3

Explain the CICO Form

3 minutes

  • Distribute the Daily Check-In Check-Out Form.
  • Walk through sections: Morning Check-In (set behavior goal), Behavior Checkboxes (check off each time you meet a goal), Afternoon Check-Out (reflect on success and set improvement steps).
  • Model filling out a sample check-in and a checkbox entry.

Step 4

Student Practice and Check

3 minutes

  • Have students complete a mock Morning Check-In on their form using the sample scenario you modeled.
  • Circulate, offer feedback, and correct misunderstandings.
  • Ask students to share one goal they wrote and affirm their commitment.
  • Explain where to place the form at day’s end and that they’ll repeat this daily.
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Slide Deck

Daily Check-In Check-Out

A simple tool to help you be Safe, Responsible, and Respectful each school day.

Welcome students and introduce the purpose: tracking daily positive behaviors using the Check-In Check-Out form.

Objectives

• Learn what “Be Safe, Be Responsible, Be Respectful” means
• Practice setting a morning behavior goal
• Check off successes throughout the day
• Reflect and plan improvements at day’s end

Explain the goal of today’s lesson: learning to use the form and understanding the three Be’s.

Review the Three Be’s

Be Safe: keep hands, feet, and body to yourself
Be Responsible: be honest and do your best work
Be Respectful: show kindness and listen to others

Define each of the three Be’s and give examples. Invite student examples to build engagement.

Check-In Check-Out Form Sections

  1. Morning Check-In: choose 1 behavior goal
  2. Behavior Checkboxes: mark each time you meet your goal
  3. Afternoon Check-Out: reflect on success
  4. Next Steps: set one improvement action

Show the four main sections of the form. Walk students through each part.

Modeling the Form

• Sample Goal: “Be Responsible by telling the truth when asked”
• Checkbox Example: Mark when you show honesty
• Afternoon Reflection: Rate yourself and write one “I will…” statement

Model a sample morning check-in using “Be Responsible: Be honest” as a goal.

Student Practice

• Complete your own Morning Check-In
• Share one goal with a partner
• Place your form in the basket when done

Guide students through a quick mock morning check-in. Circulate and give feedback.

Next Steps

• Repeat the Check-In Check-Out form every day
• Use reflections to grow stronger
• We’ll celebrate progress each week

Summarize key takeaways and remind students to use the form daily for success.

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Worksheet

Daily Check-In Check-Out Form

Name: ____________________________ Date: ____________________________

Morning Check-In

Today, I will focus on (check one):
[ ] Be Safe (keep hands, feet, and body to myself)
[ ] Be Responsible (be honest)
[ ] Be Respectful (show respect for myself, staff, and other students)

My specific goal for today:







Behavior Checkboxes

Check each time you meet your goal—place a check mark [✓] in each box.

  1. Morning Arrival:
    Be Safe [ ] Be Responsible [ ] Be Respectful [ ]



  2. After Morning Work:
    Be Safe [ ] Be Responsible [ ] Be Respectful [ ]



  3. Lunch/Recess:
    Be Safe [ ] Be Responsible [ ] Be Respectful [ ]



  4. After Recess:
    Be Safe [ ] Be Responsible [ ] Be Respectful [ ]



  5. End of Day Check-Out:
    Be Safe [ ] Be Responsible [ ] Be Respectful [ ]



Afternoon Check-Out

  1. How many times did I meet my goal today? _______
  2. Rate yourself today (1 = needs improvement, 5 = excellent): _______

What went well today?







What could I improve for tomorrow?







Next Steps

Tomorrow, I will:







Use this form each school day to track and reflect on being Safe, Responsible, and Respectful.

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