Follow discipline procedures Low Risk Moderate Risk High Risk/Imminent Advised RP / Target to consult with threat assessment Consult with Safety and Security specialist Refer for or community-based services, team, as needed and/or SRO, if necessary as appropriate Contact subject’s parents and/or guardians, if Refer subject for services to resolve Assign a case manager to monitor subject and necessary problem, if appropriate status of intervention, as appropriate Notify intended victim(s) & parents/ guardians, if Follow discipline procedures necessary Develop behavior intervention plan and/or See that perceived threat is resolved through contract, as appropriate explanation, apology, or making amends Print name of Team Leader: Date: _____________________ Signature of Team Leader: _______________________________________________________________ PART VIII. THREAT ASSESSMENT UPDATE (to be updated regularly case is active) Instructions: This section should be completed by the Team Leader, or others, as appropriate. Date of Update Disciplinary action(s) taken: Subject suspended? Yes No Subject recommended for expulsion/Termination? Yes No Subject recommended for further disciplinary action and/or consideration? Yes No Comment: Special Education? If yes: Recommendation to reconvene IEP team? Yes No Develop Functional Behavioral Assessment and/or Behavior Intervention Plan for IEP? Yes No If no, should the student be referred to Child Study or Local Screening? Yes No Comment: Actions with potential target(s) of the threat or students impacted by the threat: Designated Case Manager / Point of Contact: Offered supportive counseling? Yes No Provided brief supportive counseling? Provided Declined Communicated with targets(s) and parent(s) / guardian(s)? Yes No Altered schedule to minimize contact with subject who made the threat? Yes No Advised targets(s) and/or parent(s) or guardian(s) of their right to contact police? Yes No Name of staff member who provided this information:
Follow discipline procedures Low Risk Moderate Risk High Risk/Imminent Advised RP / Target to consult with threat assessment team, as needed Contact subject’s parents and/or guardians, if necessary Notify intended victim(s) & parents/ guardians, if necessary See that perceived threat is resolved through explanation, apology, or making amends Consult with Safety and Security specialist and/or SRO, if necessary Refer subject for services to resolve problem, if appropriate Follow discipline procedures Develop behavior intervention plan and/or contract, as appropriate Refer for or community-based services, as appropriate Assign a case manager to monitor subject and status of intervention, as appropriate Print name of Team Leader: Date: _____________________ Signature of Team Leader: _______________________________________________________________ PART VIII. THREAT ASSESSMENT UPDATE (to be updated regularly case is active) Instructions: This section should be completed by the Team Leader, or others, as appropriate. Date of Update Disciplinary action(s) taken: Subject suspended? Yes No Subject recommended for expulsion/Termination? Yes No Subject recommended for further disciplinary action and/or consideration? Yes No Comment: Special Education? If yes: Recommendation to reconvene IEP team? Yes No Develop Functional Behavioral Assessment and/or Behavior Intervention Plan for IEP? Yes No If no, should the student be referred to Child Study or Local Screening? Yes No Comment: Actions with potential target(s) of the threat or students impacted by the threat: Designated Case Manager / Point of Contact: Offered supportive counseling? Yes No Provided brief supportive counseling? Provided Declined Communicated with targets(s) and parent(s) / guardian(s)? Yes No Altered schedule to minimize contact with subject who made the threat? Yes No Advised targets(s) and/or parent(s) or guardian(s) of their right to contact police? Yes No Name of staff member who provided this information: