✨ Physical Restraint Debriefing Forms
NEW ZEALAND GAZETTE, No. 89 — 1 SEPTEMBER 2017
If there’s a next time
What could be done differently in the future to prevent the need for restraint?
How about you?
How are you feeling and what support do you need? How about others?
Signature of person who applied the restraint ____
Signatures of any staff witnesses ____
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 4: Debriefing form for staff involved in physical restraint incident
Date of incident / / __
Date of debriefing / / __ Time of debriefing __
Names of the people at the debriefing
Findings of debriefing
Next steps/actions
Principal or Principal’s delegate signature ____
Note: The information in this form may be the subject of requests made under the Privacy Act 1993 and the Official
16
Next Page →
NZ Gazette 2017, No 89
✨ LLM interpretation of page content
🎓
Information for the Ministry of Education on Physical Restraint Incidents
(continued from previous page)
🎓 Education, Culture & SciencePhysical Restraint, Incident Reporting, Ministry of Education, Employer Notification, Support Services, Data Collection