New Zealand Gazette – 2017 – No. 89

Page 17

✨ Physical Restraint Debriefing Form



NEW ZEALAND GAZETTE, No. 89 — 1 SEPTEMBER 2017

Information Act 1982.

Appendix 5: Physical restraint debriefing form – parents or caregivers, student

| Date of incident | |
| Date of debriefing | Time of debriefing |
| Names of the people at the debriefing | |

Findings of debriefing

Parent or caregiver – comments and suggestions

Student – comments and suggestions

Next steps/actions agreed

Signatures

Principal or Principal’s delegate:

Parents or caregivers:

Student:

Note: The information in this form may be the subject of requests made under the Privacy Act 1993 and the Official Information Act 1982.

  1. The reporting requirement is made in accordance with Rule 8(2) of the Education (Physical Restraint) Rules 2017.

  2. The reporting requirement is made in accordance with Rule 8(1) of the Education (Physical Restraint) Rules 2017.

2017-go4282

PUBLISHED BY THE
DEPARTMENT OF INTERNAL AFFAIRS

newzealand.govt.nz

INTERNAL AFFAIRS

PRINTED BY BLUE STAR GROUP

ISSN 0111-5650 (PRINT)
ISSN 1177-8415 (ONLINE)




Online Sources for this page:

Gazette.govt.nz — PDF NZ Gazette 2017, No 89




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🎓 Physical restraint debriefing form – parents or caregivers, student (continued from previous page)

🎓 Education, Culture & Science
Physical Restraint, Debriefing Form, Parents, Caregivers, Student, Incident Reporting, Education Rules