Written Summary of Restraint Use Sample Form
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Local Education Agencies (LEAs)Ìýmay use the Written Summary of Restraint Use Sample Form to inform parents/guardiansÌýabout the use of restraintÌýandÌýto assist in the collection of data to be reported throughÌýtheÌýPublic Education Information Management System (PEIMS).ÌýThis form has been developed pursuant to Texas Education CodeÌý(TEC)Ìý§37.0021, Use of Confinement, Restraint, Seclusion, and Time-Out and Texas Administrative CodeÌý(TAC)Ìý§89.1053, Procedures for Use of Restraint and Time-Out, specificallyÌýTACÌý§89.1053(e)(3), (4),Ìý(5), (A-I).Ìý
This form is aligned with the PEIMSÌýRestraint Event ExtensionÌýRecordÌýfound in theÌý.ÌýTheÌýformÌýmay be downloaded in either EnglishÌýorÌýSpanishÌýusingÌýthe links below.Ìý
LEAsÌýare encouraged to request technical assistance about this form, restraint and time out issues, or other behavior supportsÌýthroughÌýtheirÌýregional,ÌýEducationÌýServiceÌýCentersÌý(ESCs.).ÌýÌý
The Texas Behavior Support Initiative (TBSI) is training thatÌýsatisfies theÌýstatutoryÌýrequirementsÌýoutlined inÌýTEC §37.0021 and TAC §89.1053. TBSIÌýequips school personnelÌýwith theÌýknowledgeÌýrequired to successfully implementÌýpositive behavior interventions and supports for all students, including students with disabilities. TBSI training meets legislative requirements related to procedures for the use of restraint and time-out; however,Ìýit also provides aÌýwide-rangingÌýframework for sharing behavior strategies and prevention-based,Ìýschool-wide, classroom, and individual interventions.Ìý
The goal ofÌýTBSIÌýis toÌýprovide educators withÌýtheÌýtools necessary to effectively de-escalateÌýconflicts with students and to minimize the need for the use of time-out or restraint.ÌýSpecific trainingÌýexistsÌýwithin theÌýonline TBSI modules on how to properly document the useÌýof restraintÌýusingÌýthe Summary of Restraint Use SampleÌýForm.ÌýInterested individuals mayÌýenroll inÌýtheÌývirtual trainingÌýthrough theÌýÌýwebpage.ÌýAdditional informationÌýmay also be found by visiting theÌýÌý(TIER) website.Ìý
English VersionÌý
English Written Summary of Restraint Form (PDFÌý75.8KB)
Spanish VersionÌý
Spanish Written Summary of Restraint Form (PDF 21.8KB)Ìý
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