503.7E1 Use of Physical Restraint and/or Seclusion Documentation Form

Code 503.7E1

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Use of Physical Restraint and/or Seclusion Documentation Form

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 or guardian within three school days of the occurrence. Unless the parent or guardian agrees to receive the report by email, fax, or hand delivery, the report must be sent by mail and postmarked by the third day following the occurrence. Enclosed with a copy of this form is an invitation for the parents or guardians to participate in the debriefing meeting scheduled in accordance with the law.

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Employee Date form delivered to Parent/Guardian

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Method of Transmittal

Approved: February 16, 2021

Reviewed:

Revised: