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503.06E3 DEBRIEFING MEETING DOCUMENT

Code No.  503.06E3

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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

Cross Reference:

    402.03    Abuse of Students by School District Employees

    503.05    Corporal Punishment, Mechanical Restraint and Prone Restraint

 

Approved:      2/8/2021                                     Reviewed:  05/13/2024                           Revised:  05/13/2024

 
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