PBIS Building Information

To participate in PBIS District Information reporting and Restraint & Seclusion Incidents building reporting, use the secure link that was emailed to your district superintendent.

PBIS and Restraint & Seclusion Reporting Start Page

Restraint and Seclusion Building Incidents
for School Year 2019-2020

The building level reporting includes training for student personnel as well as restraint incidents and seclusion incidents. There are worksheets on the PBIS homepage to help you collect data for each building before entering it online.

PBIS district information and school building reporting reporting for School Year School Year 2019-2020 is available starting June 1, 2020 and is due by September 1, 2020.

Restraint & Seclusion Building Level Data

1 Building Training

2 Restraint Incidents

3 Seclusion Incidents

4 Review and Submit

School Building
Building Name (IRN)
birn
Guidance: Student personnel is defined as: teacher, principal, counselor, social worker, school resources officer, teacher’s aide, psychologist, bus driver, or other school or district staff who interact directly with students.
Did your school building student personnel received any trauma informed care training in school year 2019-2020?*
- Yes
- No

Restraint Incidents
The definition of physical restraint is the use of physical contact that immobilizes or reduces the ability of a student to move their arms, legs, body or head freely. The term does not include a physical escort, mechanical restraint or chemical restraint. The physical restraint does not include brief, but necessary contact for the following or similar purposes to:
- • break up a fight;
- • knock a weapon away from a student’s possession;
- • calm or comfort;
- • assist a student in completing a task/response if the student does not resist the contact; or
- • prevent an impulsive behavior that threatens the student’s immediate safety (e.g., running in front of a car).
Guidance: A series of disruptive student actions involving agitation, behavior leading to restraint, seclusion, or a combination of restraint and seclusion should be considered one reported incident. For example, a student restrained two times during an incident because the student was not fully calm at the time of attempted release would be counted as one report. However, a one-hour period during which time the student has returned to calm or typical functioning for the student, followed by the student becoming newly agitated and requiring restraint, seclusion, or a combination of restraint and seclusion would then generate a new (additional) reported incident.

*The use of physical restraint must be used as a last resort and only when there is an immediate risk of physical harm to the student or others and no other safe or effective intervention is possible. See full policy for full guidance and prohibited practices on restraint.
List total number of incidents of restraint, in this specific building, that occurred during the 2019-2020 school year.*
Please enter a number greater than or equal to 0.
Of the total number of incidents of restraint, did any involved students with IEP?*
- Yes
- No
Enter the number of incidents of restraint for these 13 disability categories. The total is shown below and must not be greater than the total number of incidents.
Autism*
Please enter a number greater than or equal to 0.
Intellectual Disability*
Please enter a number greater than or equal to 0.
Deaf-Blindness*
Please enter a number greater than or equal to 0.
Deafness*
Please enter a number greater than or equal to 0.
Emotional Disturbance*
Please enter a number greater than or equal to 0.
Hearing Impairment*
Please enter a number greater than or equal to 0.
Multiple Disabilities*
Please enter a number greater than or equal to 0.
Orthopedic Impairment*
Please enter a number greater than or equal to 0.
Other Health Impairment*
Please enter a number greater than or equal to 0.
Specific Learning Disability*
Please enter a number greater than or equal to 0.
Speech or Language Impairment*
Please enter a number greater than or equal to 0.
Traumatic Brain Injury*
Please enter a number greater than or equal to 0.
Visual Impairments*
Please enter a number greater than or equal to 0.
Sum of disability categories
The number above must not exceed the total number of incidents.
Total restraints minus disability categories
If the number above is negative, then the sum of disabilities categories exceeds the total number of incidents.
Provide the number of students who had multiple incidents of restraint.*
Please enter a number greater than or equal to 0.
Guidance: Your district shall conduct a Functional Behavioral Assessment (FBA) or Behavioral Intervention Plan (BIP) if any student repeatedly engages in dangerous behavior that leads to instances of restraint and/or seclusion, though a single instance of restraint and/or seclusion could necessitate a review or development of a FBA or BIP. This pertains to all students and is not exclusive to students with disabilities.
Of the total number of restrained students, provide the number of incidents which resulted in the creation or amendment of a functional behavioral assessment (FBA).*
Please enter a number greater than or equal to 0.
Of the total number of restrained students, provide the number of incidents which resulted in the creation or amendment of a behavioral intervention plan (BIP).*
Please enter a number greater than or equal to 0.
Number of students suspended due to behavior that led to restraint.*
Please enter a number greater than or equal to 0.
Number of students expelled due to behavior that led to restraint.*
Please enter a number greater than or equal to 0.
Number of reported restraint incidents that resulted in an injury to a student.*
Please enter a number greater than or equal to 0.
Number of reported restraint incidents that resulted in an injury to a staff member.*
Please enter a number greater than or equal to 0.

Seclusion Incidents
Seclusion is defined as the involuntary isolation of a student in a room, enclosure, or space from which the student is prevented from leaving by physical restraint or by a closed door or other physical barrier.
Seclusion does not include incidents when the student voluntarily moves to a separate location to calm down or reduce sensory overload as part of a behavior plan or de-escalation plan.
List the total number of incidents, in the specific building, that occurred during the 2019-2020 school year.*
Please enter a number greater than or equal to 0.
Of the total number of incidents of seclusion, did any involved students with IEP?*
- Yes
- No
Enter the number of incidents of seclusion for these 13 disability categories. The total is shown below and must not be greater than the total number of incidents.
Autism*
Please enter a number greater than or equal to 0.
Intellectual Disability*
Please enter a number greater than or equal to 0.
Deaf-Blindness*
Please enter a number greater than or equal to 0.
Deafness*
Please enter a number greater than or equal to 0.
Emotional Disturbance*
Please enter a number greater than or equal to 0.
Hearing Impairment*
Please enter a number greater than or equal to 0.
Multiple Disabilities*
Please enter a number greater than or equal to 0.
Orthopedic Impairment*
Please enter a number greater than or equal to 0.
Other Health Impairment*
Please enter a number greater than or equal to 0.
Specific Learning Disability*
Please enter a number greater than or equal to 0.
Speech or Language Impairment*
Please enter a number greater than or equal to 0.
Traumatic Brain Injury*
Please enter a number greater than or equal to 0.
Visual Impairments*
Please enter a number greater than or equal to 0.
Sum of disability categories.
The number above must not exceed the total number of incidents.
Total seclusion minus disability categories.
If the number above is negative, then the sum of disabilities categories exceeds the total number of incidents.
Provide the number of students who had multiple incidents of seclusion.*
Please enter a number greater than or equal to 0.
Guidance: Your district may conduct a Functional Behavioral Assessment (FBA) or Behavioral Intervention Plan (BIP) if any student repeatedly engages in dangerous behavior that leads to instances of restraint and/or seclusion, though a single instance of restraint and/or seclusion could necessitate a review or development of a FBA or BIP. This pertains to all students and is not exclusive to students with disabilities.
Of the total number of seclusion incidents, provide the number of incidents which resulted in the creation or amendment of a functional behavioral assessment (FBA).*
Please enter a number greater than or equal to 0.
Of the total number of seclusion incidents, provide the number of incidents which resulted in the creation or amendment who of a behavioral intervention plan (BIP).*
Please enter a number greater than or equal to 0.
Number of students suspended due to behavior that led to seclusion.*
Please enter a number greater than or equal to 0.
Number of students expelled due to behavior that led to seclusion.*
Please enter a number greater than or equal to 0.
Number of reported seclusion incidents that resulted in an injury to a student.*
Please enter a number greater than or equal to 0.
Number of reported seclusion incidents that resulted in an injury to a staff member.*
Please enter a number greater than or equal to 0.

Review and Submit
Please review all of the information you have provided on this form. Use the numbered tabs at the top to read each section to ensure that each is complete and includes accurate responses. Then, enter your name and email address and click or tap SUBMIT.
Your Name (first and last only)*
Your Email*
Name
This field is for validation purposes and should be left unchanged.

Connected by the Management Council

PBIS Building Information

Restraint and Seclusion Building Incidentsfor School Year 2019-2020

Restraint & Seclusion Building Level Data

School Building

Restraint Incidents

Seclusion Incidents

Review and Submit

Restraint and Seclusion Building Incidents
for School Year 2019-2020