Student Incidents

FBS/BSP FORMS

Restraint and Seclusion Forms
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Reporting of Student Incidents

It is necessary to document all occasions where Protective Physical Interventions (PPI)/Seclusion in some form was needed to maintain the safety of students and staff. Examples of interventions include OIS Protective Physical Interventions (PPI) and/or or seclusion.

After an incident has occurred:

    • All staff members present during the incident must complete the Use of Protective Physical Intervention (PPI)/Seclusion Incident Report

    • The parent/guardian must be notified of the PPI and/or seclusions by the end of the school day in which the incident took place. They may be notified by phone, email, or in person.

    • Copy of the completed Incident Report must be provided to the parent/guardian within 24 hours of the incident

    • Copy of the Use of Protective Physical Intervention (PPI)/Seclusion Debriefing Meeting Notes must be provided to the parent/guardian within 48 hours of the incident

    • If restraint or seclusion continues for more than 30 minutes, the student must be provided with adequate access to bathroom and water every 30 minutes. If physical restraint or seclusion continues for more than 30 minutes, every 15 minutes after the first 30 minutes an administrator for the public education program must provide written authorization for the continuation of the physical restraint or seclusion, including providing documentation for the reason the physical restraint or seclusion must be continued. Whenever physical restraint or seclusion extends beyond 30 minutes, personnel of the District will immediately attempt to verbally or electronically notify a parent.

    • Distribute copy of the Incident Report to cum file, case manager, and Student Services feeder team administrator’s secretary. A trainer will review and track the incident within one week of incident.

Documentation of a Behavioral Incident

Complete an Use of Protective Physical Intervention (PPI)/Seclusion Incident Report when any of the following have occurred.

Protective Physical Intervention was used; explanation is needed about why PPI was needed.

    1. Seclusion was used to keep a student safe.

    2. A student engaged in an unusual behavior such as, but not limited to:

        • running away

        • threatening harm to self

        • extended periods of crying

        • physical aggression

This list is not exclusive. When in doubt, fill it out.

Restraint/Seclusion Incident Report

Restraint/Seclusion Debriefing Meeting notes

Spanish Restraint/Seclusion Incident Form

Spanish Restraint/Seclusion Meeting Notes