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District Mouse of Restrictive Procedures: Physical HoldingStudent: School: Birth date: Federal setting: Primary disability:SSID: Age: Gender:Date of incident: Grade:A. Is the student Hispanic/Latino?

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How to fill out use of restrictive procedures

01

Identify the need for restrictive procedures based on the individual's behavior

02

Develop a person-centered plan that includes alternative strategies to address the behavior

03

Obtain informed consent from the individual or their legal guardian

04

Ensure proper training for staff members on how to safely implement restrictive procedures

05

Implement restrictive procedures only as a last resort and for the shortest duration possible

06

Monitor the individual's response to the restrictive procedures and make adjustments as needed

07

Regularly review and update the person-centered plan to minimize the use of restrictive procedures

Who needs use of restrictive procedures?

01

Individuals who exhibit behaviors that pose a risk to themselves or others

02

Individuals who have not responded to less restrictive interventions

03

Individuals with developmental disabilities, mental health conditions, or other special needs

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What is use of restrictive procedures?

The use of restrictive procedures is to regulate and monitor the application of measures that restrict an individual's freedom or rights.

Who is required to file use of restrictive procedures?

Healthcare facilities, residential care facilities, and other organizations that utilize restrictive procedures are required to file.

How to fill out use of restrictive procedures?

The use of restrictive procedures form typically requires detailed information about the individual, the type of restriction used, the reason for the restriction, and any alternatives considered.

What is the purpose of use of restrictive procedures?

The purpose of use of restrictive procedures is to ensure that the rights and dignity of individuals are protected while also maintaining their safety and the safety of others.

What information must be reported on use of restrictive procedures?

Information such as the individual's name, the type of restriction used, the reason for the restriction, the date and time it was implemented, and any documentation or assessments related to the decision.

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