503.6E3 - Debriefing Meeting Document

Student name:

Date of occurrence:

Date of debriefing meeting:

Time of debriefing meeting:

Location of debriefing meeting:

 

Names of individuals attending the debriefing meeting (must include the employees involved and at least one employee who was not involved):

Job title of employee and/or relation to student:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Documentation reviewed during meeting (must include at least the occurrence report; and BIP, IHP, IEP and/or safety plan if applicable):

 

 

 

 

 

Identification of patterns of behavior and proportionate response, if any, in the student and employees involved:

 

 

 

 

 

Possible alternative responses, if any, to the incident/less restrictive means, if any:

 

 

 

 
     

 

Additional resources, if any, that could facilitate those alternative responses in the future:

 

 

 

 

 

Plans for additional follow up actions, if any:

 

 

 

 

 

 

This form has been reviewed and completed by the undersigned employee.  A written copy of this form has been sent to the student’s guardian within three school days of the debriefing meeting.

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Employee                                                                          Date of delivered to Parent/Guardian

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Method of Transmittal