Elimination Record

CHILD’S NAME: ____________________________________________________________________

DATE BEGUN: _____________________________________________________________________

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

Time Pants Toilet Pants Toilet Pants Toilet Pants Toilet Pants Toilet Pants Toilet Pants Toilet 7:00 8:00 9:00 10:00 11:00 12:00 1:00 2:00 3:00 4:00 5:00 6:00 7:00

From Steps to Independence, Fourth Edition. Copyright 2004 by Paul H. Brookes Publishing Co., Inc. All rights reserved.