[The following individuals must attend the debriefing meeting: employees who administered physical restraint or seclusion; an administrator or employee not involved in the occurrence; the administrator or employee who approved continuation of the physical restraint or seclusion; other relevant personnel designated by the school; if indicated by student’s behavior in occurrence, an expert in behavioral/mental health or other discipline. The following individuals must be invited to attend the debriefing meeting: the parent or guardian of the student, the student with guardian’s consent.]
| Student name | Date of occurrence | ||
|---|---|---|---|
| Date of debriefing meeting | Time of debriefing meeting | ||
| Location of debriefing meeting | |||
| Names of individuals attending the debriefing meeting (must include the employees involved and at least one employee who was not involved) | Job title of employee and/or relation to student | ||
| Documentation reviewed during meeting (must include at least the occurrence report; and BIP, IHP, IEP and/or safety plan if applicable) | |||
| Identification of patterns of behavior and proportionate response, if any, in the student and employees involved | |||
| Possible alternative responses, if any, to the incident/less restrictive means, if any | |||
| Additional resources, if any, that could facilitate those alternative responses in the future | |||
| Plans for additional follow up actions, if any | |||
This form has been reviewed and completed by the undersigned employee. A written copy of this form has been sent to the student’s guardian within three school days of the debriefing meeting.
| Employee | |
|---|---|
| Date of delivered to Parent/Guardian | |
| Method of Transmittal |