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[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/guardian of the student and the student with parent/guardian’s consent.]
Student Name:
Building:
Date of Original Occurrence:
Date of Debriefing Meeting:
Time of Meeting:
Location of Meeting:
Names, titles of employees, and/or relation to student of individuals attending the debriefing meeting (must include the employees involved and at least one employee who was not involved):
Documentation reviewed during the meeting (must include at least the occurrence report and BIP, IHP, IEP, and/or safety plan if applicable):
Identification of patterns or 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 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 parent/guardian within three (3) school days of the debriefing meeting.
Names and Title of Employee Completing Form:
Date:
Date Delivered to Parent/Guardian:
Method of Transmittal:
Adopted: 2/21
Reviewed: 10/23
Revised: 10/26
Related Policy: 502.14; 502.14-R, 502.14-E1-E2
IASB Reference: 503.60-E(3)