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May 2012 ACTION ASTROPHYSICAL RESTRAINT AND SECLUSION IN SCHOOLSATTENTION: Parents, family members, advocates or students with disabilities who have been or know of someone that has been physically
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How to fill out physical restraint and seclusion

01
To fill out a physical restraint and seclusion form, follow these steps:
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Begin by gathering all the necessary information about the person who will be subjected to the physical restraint or seclusion.
03
Clearly identify the reason for the physical restraint or seclusion and document it on the form.
04
Document the date and time when the physical restraint or seclusion began.
05
Specify the type of physical restraint or seclusion used.
06
Record any observations or changes in behavior during the physical restraint or seclusion period.
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Continuously monitor the person under restraint or seclusion and document their physical and mental state.
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If applicable, document any attempts to de-escalate the situation or alternatives to physical restraint or seclusion that were tried.
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Finally, once the physical restraint or seclusion period has ended, document the date and time of its termination on the form.
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Make sure to follow your organization's guidelines and regulations while filling out the form.

Who needs physical restraint and seclusion?

01
The use of physical restraint and seclusion should only be considered for individuals who pose an imminent risk of harm to themselves or others and only as a last resort when all other de-escalation techniques have failed.
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It is important to note that physical restraint and seclusion should only be used in accordance with applicable laws, regulations, and ethical guidelines.
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The decision to use physical restraint and seclusion should be made by a qualified healthcare professional or authorized personnel after a thorough assessment of the situation and consideration of less restrictive alternatives.
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Individuals who may need physical restraint and seclusion include but are not limited to:
05
- Patients in psychiatric facilities or hospitals who are exhibiting violent or self-destructive behavior.
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- Individuals with severe behavioral or developmental disorders who present a danger to themselves or others.
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- Children or adolescents who may become a risk to themselves or others due to extreme emotional distress.
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It is crucial to ensure that the use of physical restraint and seclusion is used judiciously and with the utmost care to protect the well-being and dignity of the individuals involved.

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Physical restraint involves restricting an individual's movement using devices or manual methods. Seclusion involves confining an individual alone in a room or area from which they are physically prevented from leaving.
The individuals or facilities providing care or services to the individual who experienced physical restraint and seclusion are required to file the report.
The report should include details such as the date, time, location, duration, reason for physical restraint and seclusion, interventions used, and any injuries sustained.
The purpose is to ensure the safety of the individual and others, as well as to prevent harm or injury.
Information such as the individual's personal details, the circumstances leading to physical restraint and seclusion, and any interventions used must be reported.
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