# 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.