Restraint & Seclusion - 24 Hour Report

Enter the name of the School or Program for which the incident occurred

Choose your district from the drop down list

Enter the name of the individual ODE can contact in regards to this incident. This is the "Contact".

Contact person email address

Enter phone number to reach contact person (555-555-5555)

Choose the date the incident occurred

What time did the incident occur?

Example 12:45 PM

Enter the first and last name of the staff member that was seriously injured, or died due to the incident

Please select the classification associated with the staff member listed above