Restraint Notification Procedures for Special Education Students Checklist

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1 In the event of a containment of a Special Education student: 1. Follow the procedures outlined in Operating Guidelines: Restraint of Students with Disabilities 2. Complete each step in this checklist (Step in parentheses refers to applicable step in the Operating Guidelines). 3. Initial and date each step in this checklist 4. Sign and date the completed checklist at the bottom 5. Return the completed & signed restraint documentation with signed/dated checklist to SpEd Department PEIMS Specialist On the day of the Restraint (initial and date each step): Student visited nurse once he/she de-escalated (Step 6a) Staff members involved in the restraint visited nurse (Step 6a) Campus Principal and Special Education Director were notified verbally and in writing (Step 6e) Restraint Documentation in esped completed, following directions on esped screenshots (Step 6b, 6c, 6d, 6f) State only facts Avoid potentially inflammatory descriptors Share information about the incident only with those who have a legitimate educational interest Seek help of SpEd Assessment Coordinator ( ) in completing the restraint documentation Campus Principal, those listed as administering the restraint, and staff members making parent/adult student contact signed the documents next to their name after having carefully proofed all documents (Step 7) Parent/adult student notified (Step 8a) Parent Contact Log in esped completed, following directions on esped screenshots (Step 6bi) 3 copies of the report were made and disseminated within 24 hours to: Parent/adult student (check one: mailed hand-delivered) on (date) (Step 8bi) Campus Principal (Step 8biii) Student s campus case folder (Step 8biii) Original completed & signed restraint documentation with signed/dated checklist was sent to the SpEd Department s PEIMS Specialist (Step 8c) SIGNED: DATE:

2 Completing the Parent Contact Log in esped 1. From the esped home screen, select ARD Forms from the left side of screen. 2. Search for the student name and enter the FERPA justification. 3. Once on the first screen, use the drop down box and locate the Restraint Documentation screen. 4. From the Screen dropdown menu, locate and select Parent Contact Log.

3 5. Click the Add Documentation button. 6. Fill out all requested text fields. 7. Click Save when finished filling out the form. Completing Restraint Documentation in esped 1. From the esped home screen, select ARD Forms from the left side of screen.

4 2. Search for the student name and enter the FERPA justification. 3. Once on the first screen, use the drop down box and locate the Restraint Documentation screen. 4. From the Screen dropdown menu, locate and select Restraint Documentation. Click this arrow to scroll down to the following screens.

5 5. Click on the Restraint Documentation Screen. 6. Click the Add Restraint button. 7. Fill out all requested text fields. 8. Click Save when finished filling out the form. Printing Out Report/Form 1. Identify the restraint form you want to print out. 2. Check the box that corresponds with the report/form you wish to print under the Print on Report column. If you don t check the box, your form will print blank. 3. Click the Reports tab above the drop-down menu.

6 4. From the Screen drop-down menu, choose Print Multiple Reports option. 5. Scroll down the list of Available Report Pages and double click. a. Restraint: Cover Letter b. Restraint: Written Summary of Restraint Use c. Restraint: Internal Tracking Review d. Parent Contact Log 6. Click Create button. a. This will take you to the View Prepared Reports screen, click Refresh button until your restraint reports are DONE. 7. Click View button to left of student s name. 8. Print, get signatures, and then scan and upload/archive the signed copy of the Cover letter, Written Summary of Restraint Use, Internal Tracking Review and Parent Contact Log into esped. Scan and Archive Forms in esped 1. Scan and yourself the signed copy of the Cover letter, Written Summary of Restraint Use, and Internal Tracking Review. 2. Open the document and save it to your computer, flash drive, etc. 3. Access esped. 4. On the left side of the esped home screen, please select Archive Manager.

7 5. Search for the student name and enter the FERPA justification. 6. Click Upload Document from Screen 1 of Archive Manager. 7. Upload your document by clicking on Choose File and selecting the appropriate document. 8. After selecting the appropriate document, click Send it to the Server.

8 9. A new window will pop up titled Archive Information. In the text field for Document Title, you will enter the title for the document. a. For containments, please use the following document title: Restraint: month/date/year. (example: Restraint: 02/23/2017. b. If a student required multiple containments during one school day, then please indicate this by adding the incident number after the date. For example, if a student was contained twice in one day you would upload one form as: Restraint: 9/09/2016: #1 and the other as Restraint: 02/23/2017: #2

9 10. Then select the appropriate Folder by activating the dropdown menu. Choose the correct school year in the folder. 11. Next click Save. 12. Go back to the esped home screen select ARD Forms from the left side of screen. 13. Search for the student name and enter the FERPA justification. 14. Once on the first screen, use the drop down box and locate the Restraint Documentation screen. 15. From the Screen dropdown menu, locate and select Restraint Documentation. 16. Click the Delete button. 17. From the Screen dropdown menu, locate and select Parent Contact Log. 18. Click the Delete button.

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