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Incident Reports: Seclusion Form - sde ct

Incident Reports: Seclusion Form - sde ct 2026

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The document is an Incident Report of Seclusion from the Connecticut State Department of Education, outlining the procedures and requirements for documenting instances of seclusion in public schools. It defines seclusion, provides a structured format for reporting incidents, and emphasizes the importance of timely documentation, parent notification, and monitoring student well-being during and after seclusion.

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Click ‘Get Form’ to open the Incident Reports: Seclusion Form in the editor.
Begin by filling in the District Information section. Enter the School District name, address, and phone number, along with the specific school details.
Next, provide the Date of Seclusion and Date of Report. Include your name as the person preparing the report, along with the times for when seclusion was initiated and ended.
In the Student Information section, input the student's name, SASID number, date of birth, age, gender, grade, race, and disability status. Indicate if they receive special education services or are being evaluated for eligibility.
Complete the Staff Information section by entering names and titles of staff involved in administering and monitoring seclusion.
Describe the student’s behavior that led to seclusion and any risks involved. Document de-escalation strategies used prior to seclusion.
Detail whether physical distress was observed during seclusion and describe how the student was monitored.
Finally, confirm parent/guardian notification details and whether a PPT is recommended to modify the IEP.

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What is an example of seclusion restraint?

Seclusion is when a person is placed alone in a room and cannot leave by themselves. An example is a room with a door that locks and unlocks from the outside. Restraint is when a person is held to stop them moving their body.

What are the risks of seclusion?

Emotional Distress and Isolation: Seclusion can induce feelings of loneliness and emotional distress, especially if the individual already struggles with social interactions or mental health issues. Prolonged isolation may exacerbate depression and anxiety symptoms.

Who fills out an incident report form?

The supervisor should verify the information in the report. Only the person that is directly involved in the incident can fill out the form. Be thorough and avoid making corrections. Proofread.

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What is the difference between restraint and seclusion?

Under that definition, any hold educators place on students that limits their physical ability counts as a restraint, Jones said. Seclusion refers to the involuntary confinement of a student alone in a room or area from which the student is physically prevented from leaving, ing to the department.

What is seclusion in CT?

(7) Seclusion means the confinement of a person in a room, whether alone or with staff supervision, in a manner that prevents the person from leaving, except that in the case of seclusion at Long Lane School, the term does not include the placing of a single child or youth in a secure room for the purpose of sleeping

What is the legal definition of seclusion?

Seclusion means the involuntary confinement of a person in a room or an area from which the person is physically prevented from leaving for any period, with the purpose of modifying a behavior.

Incident Reports: Seclusion Form - sde ct 2026

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