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ABR RESTRAINT INCIDENT REPORT (24)
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DATE OF INCIDENT:    

!incident_date__text!

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TIME:  

!incident_time_text!

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CLIENT INVOLVED:    

!client_text!

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STAFF INVOLVED:    

!staff_involved_text!

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WITNESSES:   

!witnesses_text!

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LOCATION:    

!location_text!

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PRECIPITATING FACTORS (WHAT WAS HAPPENING BEFORE RESTRAINT):   

!ppting_factors_text!

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ATTEMPTS TO AVOID:   

!attempts_to_avoid_text!

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DESCRIBE DANGER-TO CHILD OR OTHERS:   

!describe_danger_text!

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TIME RESTRAINT BEGAN:   

!time_began_restraint_text!

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DESCRIBE INITIATING RESTRAINT (INCLUDE ALL HOLDS USED):   

!describe_initiating!

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DESCRIBE MIDDLE PHASE OF RESTRAINT:   

!describe_middle_text!

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DESCRIBE ENDING PHASE OF RESTRAINT:   

!describe_end_text!

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TIME RESTRAINT ENDED:   

!time_ended_text!

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DURING 15 MIN IMMEDIATELY FOLLOWING THE RESTRAINT WHAT WHERE YOUR OBSERVATIONS AND THE CONVERSATION BETWEEN YOU AND THE CHILD (ESPECIALLY INCLUDE THE CHILD'S PERCEPTION OF THE CONVERSATION):   

!observation_conversation_text!

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TRANSITION TO CURRENT STATUS:   

!transition_to_current_status_text!

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NOTIFICATION DATE:    

!notify_date_text!

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NOTIFICATION TIME:    

!notify_time_text!

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NOTIFICATIONS:   

!notification_text!

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SUGGESTED(REQUIRED) FURTHER ACTION:   

!further_action_text!

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