Emergency Safety Intervention Description of Incident - English

The purpose of this letter is to inform you that on MM-DD-YYYY Intervention was required for XXXXX.

Description of Incident

Type of Emergency Safety Intervention Used:

School Personnel Who Participated in or Supervised the Incident:  

Witnesses:

Clear explanation of the immediate danger to the students or others:

Any de-escalation techniques used prior to the ESI:

Description of the ESI used:

Steps taken to transition student back into the educational setting:

Outcome of the incident:

Please contact the building principal if you have any questions regarding this use of ESI.

_______________________________________________      ___________________
(Signature of person completing report)                 (Date)

*Parent(s)/guardian(s) notified of this incident on MM-DD-YYYY by XXXXX.