Form 699N January 2017 Page 1 of 1 Post Incident/Physical Restraint Protocol Guideline GUIDELINE OF PROCEDURES TO BE CONSIDERED FOLLOWING AN INCIDENT/PHYSICAL RESTRAINT, WHERE APPLICABLE. Where appropriate the procedures listed below should be followed. Injuries assessed and appropriate medical intervention Yes D No D NA D accessed: School Administration contacted: Yes D No D Parents contacted: Yes D No D Staff debriefed: Yes D No D Follow-up support provided to staff: D D Yes No Follow-up support provided to student: Yes D No D Follow-up support provided to victim: D D Yes No Ministry of Education Violent Incident Form Special Yes D No D Education Student (IPRC’d) completed (not necessary for planned physical restraint): of Workplace Violent Incident Form Yes D No D Employee’s Report completed on-line Yes D No D Completion of entry into student’s behaviour Yes D No D log (for planned or occasional restraints): Behaviour/Safety plans reviewed and amended as required Yes D No D (or created for unplanned physical restraint): If injury, completion/submission of TDSB Employee’s Report Yes D No D of Accident Injury Form Caring and Safe Schools informed: D D Yes No Superintendent of Education informed: Yes D No D Case conference scheduled: D D Yes No Yes D No D Completed a Management of Risk of Injury Summary Staff training requested: D D Yes No
Post Incident/Physical Restraint Protocol Guideline Form 699N January 2017 Page 1 of 1 GUIDELINE OF PROCEDURES TO BE CONSIDERED FOLLOWING AN INCIDENT/PHYSICAL RESTRAINT, WHERE APPLICABLE. Where appropriate the procedures listed below should be followed. Injuries assessed and appropriate medical intervention accessed: Yes D No D NA D School Administration contacted: Yes D No D Parents contacted: Yes D No D Staff debriefed: Yes D No D Follow-up support provided to staff: Yes D No D Follow-up support provided to student: Yes D No D Follow-up support provided to victim: Yes D No D Ministry of Education Violent Incident Form Special Education Student (IPRC’d) completed (not necessary for planned physical restraint): Yes D No D Employee’s Report of Workplace Violent Incident Form completed on-line Yes D No D Yes D No D Completion of entry into student’s behaviour log (for planned or occasional restraints): Yes D No D Behaviour/Safety plans reviewed and amended as required (or created for unplanned physical restraint): Yes D No D If injury, completion/submission of TDSB Employee’s Report of Accident Injury Form Yes D No D Caring and Safe Schools informed: Yes D No D Superintendent of Education informed: Yes D No D Case conference scheduled: Yes D No D Completed a Management of Risk of Injury Summary Yes D No D Staff training requested: Yes D No D
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