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Behavior Incident Report (BIR) Checklist

Guidance Sheet for filling out BIR online

Sample BIR

Debrief Requirements and Agenda

Debrief Meeting Form

Debrief Meeting Form Example

Parent Notification Letter- Same Day

Parent Notification Letter- 24 Hour

Monitoring Form-- Use if restraint/seclusion is over 30 minutes


Table of Contents

During restraint:


  1. Notify administrator as soon as practical that physical restraint/seclusion has begun.

  2. Student must have access to bathroom and/or water every 30 minutes.

  3. After first 30 minutes, administrator must provide written authorization to continue the physical restraint and/or inclusion and every 15 minutes after that.

    1. Fill out monitoring form

  4. If restraint/seclusion lasts longer than 30 minutes, school personnel will immediately attempt to verbally or electronically notify a parent.


After restraint:


  1. Administer notified when physical restraint and/or seclusion has happened.

  2. Monitoring form completed during physical restraint and/or seclusion.

  3. Verbal or electronic notification of parents of physical restraint and/or seclusion by end of same work day. (See Same Day Parent Notification Letter.  This may be cut and pasted into an email.)

    1. Teacher/staff may choose to use the 24 hour Parent Notification Letter in place of the Same day Parent Notification letter and only do one notification.

  4. Written documentation to parents within 24 hours of incident. Email is okay for written documentation.  Form letter includes:

    1. A description of the physical restraint and/or seclusion

    2. Date

    3. The time of the physical restraint/inclusion began and ended and the location

    4. The efforts used to de-escalate the situation and the alternatives to physical restraint or seclusion were attempted

    5. The names of personnel of the public education who administered the physical restraint or seclusion

    6. Staff trained or NOT trained

      1. If not trained, why

    7. Please contact us if you want to participate in the debriefing of this incident.
  5. BIR form completed prior to debrief.

  6. Debrief happens within two school days of incident.

    1. Administrator is part of the debriefing team in person or by reviewing notes.

    2. Staff members involved in incident present at meeting.

  7. Written notes taken at debriefing meeting.

    1. Copy of written notes provided to parent/guardian

  8. After four incidences, a team consisting of school members and parent/guardian must be formed to review and revise the student’s behavior plan and ensuring the provision of any necessary behavior supports.

BIR Checklist

Guidance Sheet

Filling out the BIR online

Sample BIR

  1. Debrief requirements:

    1. Staff members involved attend meeting

    2. Written notes taken during meeting

    3. Administrator reviews notes and signs off on them.


Debrief Team Roles:

  1. Identify roles

    1. Coordinator

    2. Recorder

    3. Lead Staff (staff member involved in incident)

    4. Time Keeper

Meeting Agenda:

  1. Coordinator welcomes team members, introductions if necessary.  (1 minute)

    1. Confirms meeting purpose, team roles, outcomes, agenda, and timelines

  2. Incident Review(2-3 minutes)

    1. Review triggers/signals observed before incident

    2. Incident

    3. Injuries or unusual events

  3. Clarifying Questions(1 minutes)

  4. What could be done differently (if needed)(2-3 minutes)

    1. Suggestions presented without critique

  5. Review current pbsb(if needed)(2-3 minutes)

    1. Match of interventions to current incident (triggers,etc)

  6. Next steps discussed(4-5 minutes)

    1. Identify any changes to current strategies

    2. Identify if additional support is needed for student’s staff

    3. Followup meeting scheduled if necessary

  7. Summarize and Close(1-2 minutes)

    1. Team Coordinator verbally summarizes major points of the meeting and prompts about next steps


Debrief Requirements and Agenda

BIR Checklist