✨ Physical Restraint Forms
NEW ZEALAND GAZETTE, No. 89 — 1 SEPTEMBER 2017
Why was the use of physical restraint considered necessary?
Serious and imminent risk to the safety of the student or any other person – describe
Any other comments
Complete the form above and email it to the Ministry of Education at physical.restraint@education.govt.nz. Provide a copy to the employer (board of trustees, sponsor of a partnership school kura hourua, or manager of a private school)
Note: The information in this form may be the subject of requests made under the Privacy Act 1993 and the Official Information Act 1982.
Appendix 3: Staff reflection form
Events leading to the incident
Describe what was happening before the behaviour started to escalate. What was the student doing? What do you think might have triggered the behaviour? How were other students reacting to the student?
Behaviour of the student
What did you notice about the student’s behaviour that alerted you that they were struggling to cope? Think about the way they looked, for example facial expressions, physical signs, language.
What did you try before the restraint?
Describe the alternative techniques and interventions tried to prevent the emergency, including a description of the de-escalation strategies you used. What was the response from the student?
The restraint method used
Describe the nature of the physical restraint. Include the type of hold and number of people required.
Monitoring
Describe how the student’s physical and emotional distress was monitored while they were restrained.
After the restraint ended
Describe the mood of the student following the restraint. What help and support were they offered?
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NZ Gazette 2017, No 89
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Information for the Ministry of Education on Physical Restraint Incidents
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🎓 Education, Culture & SciencePhysical Restraint, Incident Reporting, Ministry of Education, Employer Notification, Support Services, Data Collection