503.06-E(3) - Debriefing Meeting Document

[The following individuals must attend the debriefing meeting: employees who administered physical  restraint or seclusion; an administrator or employee not involved in the occurrence; the administrator  or employee who approved continuation of the physical restraint or seclusion; other relevant personnel  designated by the school; if indicated by student’s behavior in occurrence, an expert in 

behavioral/mental health or other discipline. The following individuals must be invited to attend the  debriefing meeting: the parent or guardian of the student, the student with guardian’s consent.]

 

Student name:

Date of occurrence:

Date of debriefing meeting:

Time of debriefing meeting:

Location of debriefing meeting:

 

Names of individuals attending the debriefing meeting (must  include the employees involved and at least one employee who  was not involved):

Job title of employee and/or  relation to student:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Documentation reviewed during meeting (must include at least the occurrence report; and BIP, IHP,  IEP and/or safety plan if applicable):

 

 

 

 

 

Identification of patterns of behavior and proportionate response, if any, in the student and employees  involved:

 

 

 

 

 

Possible alternative responses, if any, to the incident/less restrictive means, if any:

 

 

 

 
     

Additional resources, if any, that could facilitate those alternative responses in the future:

 

 

 

 

 

Plans for additional follow up actions, if any:

 

 

 

 

 

 

 

This form has been reviewed and completed by the undersigned employee. A written copy of this form  has been sent to the student’s guardian within three school days of the debriefing meeting. 

 

 

____________________________________              ______________________________
Employee                                                                                     Date of delivered to Parent/Guardian

 

 

 

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Method of Transmittal

 

 

I.C. Iowa Code                                      Description
Iowa Code § 279.8                                 Directors - General Rules - Bonds of Employees
Iowa Code § 280.21                              Corporal Punishment

I.A.C. Iowa Administrative Code           Description
281 I.A.C. 103                                      Corporal Punishment, Physical Restraint, Seclusion

Cross References  402.03  Abuse of Students by School District Employees
                                       503.05  Corporal Punishment, Mechanical Restraint and Prone Restraint  

Approved: 2/25/2026
Reviewed: 1/28/2026
Revised: 1/28/2026