Leveled Break Request Cards

About this resource

EVERYTHING INSIDE — 21 pages, 244 type-in fields

• 5 cards, 2 inches square: three color signal levels (Green, Yellow, Red) and a two-part break pass (Break Pass, I'm Back), shown large and cut apart together on one sheet
• Every card twice: a full-color set for a laminated board and a black-and-white ink-saver set for the photocopier
• A Break Request Board with a MY SIGNAL slot, a PASS slot and an I'M BACK pocket, plus two desk-size boards on one sheet for a folder or a second setting
• 12 blank signal cards with a type-in word line, for a fourth color or anything the printed set does not cover
• A how-to page: before the first day, the three moves every time, what happens while the break is running, what the colors do not decide, writing down what changes, when yellow does not lead to red
• A Signal and Break Log (16 rows: date, time, level shown, pass used, duration in minutes, returned to green on own Y/N, initials)
• A weekly roll-up (8 weeks) with a percent-returned-to-green-on-own graph
• A filled example — an invented student, one day on the log and three weeks on the roll-up, every percent re-counted from its own row
• A family page with the whole small system (all five cards) sent home on one sheet
• A hand-off page so a paraprofessional or another classroom runs the same system the same way
• A phrase bank: 24 lines in 6 groups (spoken lines for the signal, written starters for the log, the roll-up and the note home)
• A storage and binder label sheet: 11 labels and a spine strip
• Start Here, a contents page with page thumbnails, and a "what's next" back page

A color-coded way for a student to say how they are doing, in three levels, with one physical object — a break pass — that goes out to an adult and comes back. Most break systems stop at a single request card; this one adds a signal scale underneath it, plus the log, the weekly roll-up and the phrase bank that turn a card shown or a pass handed over into a line on a page a case manager can bring to a meeting.

The Cards

• Signal levels (3) — Green ("I'm okay"), Yellow ("I need a minute"), Red ("I need a break now")
• Break pass (2) — Break Pass (handed to an adult at a RED signal) and I'm Back (handed back when the break ends)

Every picture was chosen to be named in one word by a young child, in color AND in the black-and-white set. Green is a thumbs-up; yellow and red reuse the same hourglass and couch pictures this store's other request-card sets already use for "wait" and "break," so a buyer who owns more than one Visual Supports product sees the same picture mean the same thing everywhere. Cards are 2 inches square; the board slots are 2.25 inches so a card sits inside with room for a velcro dot.

The Board

• Break Request Board — a MY SIGNAL panel and a PASS panel with a name line, and an I'M BACK pocket along the bottom for finished pass cards.
• Two desk-size break request boards — two boards on one sheet, cut apart, for a folder or a second setting.

The boards carry no pictures, so they print the same in color or black and white.

What This Is, And What It Is Not

It is a fillable PDF: type into the board's name line, the log, the roll-up, the family page, the hand-off page and the blank cards, or print and use a pen. The card pages print on cardstock or plain paper and cut along dashed lines. It works offline with no account or subscription. It is NOT an editable online slideshow or word-processor document.

It is a way for a student to signal how they are doing in three colors, and to request and return a break with one physical object. It is not a behavior plan, a point system with rules of its own, or a program of any kind, and it promises no outcome. It carries no prompt hierarchy, fading schedule or mastery rule; how the system is used with a student, and for how long, is what your team's plan says. The goal line and the criterion field are blanks for your district's own wording and your team's own number. The log counts one thing: whether the student returned to green on their own.

Who This Is For

More In The Collection

This is one of several request and communication card sets in the Visual Supports Collection, alongside Break Cards and Choice Board and AAC Basic Needs and Wants Board; more picture-card sets are being added to the collection regularly, all on the same cards-plus-data shape.

Pictures (color pages): Noto Emoji by Google, Apache License 2.0. Pictures (ink-saver pages): Fluent Emoji, Copyright (c) Microsoft Corporation, MIT License.