Get Ks Emergency Safety Intervention (esi) Reporting Form - Sedgwick County 2015-2025

The KS Emergency Safety Intervention (ESI) Reporting Form is a crucial document for reporting incidents of seclusion and restraint within educational settings. This guide will assist you in completing the form accurately and efficiently online.

Follow the steps to complete the ESI Reporting Form effectively.

1. Click ‘Get Form’ button to access the form and open it in an online editor.
2. Begin filling out the student information section, which includes the student's name, grade level, special education teacher's name, site of the emergency safety intervention, and the date of the report.
3. In the next section, provide your name as the person completing the report, the date of seclusion, and the name of the person who initiated the seclusion.
4. Detail the precipitating behavior that led to the incident, the time when seclusion began, and any comments that may be pertinent to the situation.
5. Indicate when the seclusion ended and the total duration of seclusion. Include information regarding whether the student had a written statement from a licensed healthcare provider concerning any medical conditions that may affect their safety during seclusion.
6. Fill in the date of restraint, along with the names of those who assisted or witnessed the incident. Document the person who initiated restraint.
7. Describe the activity the student was engaged in prior to the restraint and explain the behavior prompting restraint. Check any imminent dangers related to physical harm or property destruction.
8. Outline the efforts made to de-escalate the situation and any alternatives to restraint utilized. This may include verbal redirection, calming techniques, or removal of other students.
9. In the description of physical restraint section, document when the restraint began, the total duration, and monitor for any signs of distress.
10. Detail how the restraint ended and any observations made post-restraint at ten-minute intervals for up to thirty minutes.
11. Address any injuries that may have occurred during the incident, specifying how these injuries will be managed without mentioning any names.
12. Conclude the form by detailing the follow-up actions taken by the school, including staff debriefing and contact with parents or IEP team members.
13. Once all fields are filled out thoroughly, you can save your changes, download the document for your records, print a physical copy for submission, or share it as necessary.

Complete your KS Emergency Safety Intervention Reporting Form online today for prompt submission.