503.6E3 - Debriefing Meeting Document

DEBRIEFING MEETING DOCUMENT

 

[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