Sped618 2025

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4 out of 5

31 votes

The document is an Emergency Safety Intervention (ESI) Reporting Form used by Sedgwick County Area Educational Services Interlocal Cooperative #618. It outlines the procedures for documenting incidents of seclusion and restraint involving students, including sections for student information, details of the incident, efforts made to de-escalate the situation, descriptions of physical restraint used, injury status, and follow-up actions required. The form emphasizes the importance of monitoring students during restraint and ensuring proper communication with parents and legal decision-makers.

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Click ‘Get Form’ to open the sped618 document in the editor.
Begin by filling out the 'Student Information' section, including the student's name, date of report, grade level, and the special education teacher's name.
In the 'Site of ESI' field, specify where the emergency safety intervention took place. Ensure to sign and date where indicated.
Document the 'Precipitating Behavior' that led to seclusion, along with the start and end times of seclusion. Note any comments that may provide context.
If applicable, indicate whether a written statement from a healthcare provider exists regarding potential risks associated with seclusion.
For restraint incidents, fill in details such as date of restraint, those assisting or witnessing, and describe student behavior prompting restraint.
Complete sections on efforts made to de-escalate situations and describe physical restraint used. Include monitoring evaluations post-restraint.
Finally, outline follow-up actions required by the school regarding staff debriefing and communication with parents or IEP team members.

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Versions	Form popularity	Fillable & printable
2015	4 Satisfied (31 Votes)

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