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Health and Safety Committee 
Memo 
Blueprint For a Violent Incident Involving a Student
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November 1, 2003
Blue Print For A Violent Incident Involving A Student
This blueprint is intended as a general guideline with suggested procedures to help teachers when a violent incident occurs.
Please note: the Health and Safety Officer, Jim Bowie (extension 879) may be contacted at any time during the following process.
Upper Grand
Elementary Teachers Federation
519-837-0090
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Violent Incident
- Teacher reports incident to Principal, Vice-Principal or Designate.
- Teacher and Principal ,Vice-Principal or Designate fill out forms 4301-1 and 206-1 and Principal, Vice-Principal or Designate sends them to appropriate personnel.
- Principal decides on consequences for student.
- Principal and key staff involved with student will form an In-school Behaviour Team and create a Behaviour Plan to set positive behavioural expectations to help prevent incident from recurring. Plan will include goals/expectations, strategies and consequences to answer...What can we do to prevent violent behaviour from recurring and keep everyone safe?
- Teacher documents all details of what occurred and the Principal’s responses for their own records.
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Another Violent Incident
- Teacher reports incident to Principal, Vice-principal or Designate.
- Teacher and Principal, Vice-Principal or Designate fill out forms 4301-1 and 206-1 and Principal, Vice-Principal or Designate sends them to appropriate personnel.
- Principal decides on consequences for student.
- Principal and key staff involved with student will review the Behaviour Plan to see what needs to be added or changed to prevent violent incident from recurring. Plan will include goals/expectations, strategies and consequences to answer...What can we do to prevent violent behaviour from recurring and keep everyone safe?
- Principal and key staff will consider asking the Support Behaviour Team for help
- Teacher documents all details of what occurred and the Principal’s responses for their own records.
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Another Violent Incident
- Teacher reports incident to Principal, Vice-Principal or Designate.
- Teacher and Principal, Vice-Principal or Designate fill out forms 4301-1 and 206-1 and Principal, Vice-Principal or Designate sends them to appropriate personnel.
- Principal decides on consequences for student.
- Principal and key staff involved with student will review the Behaviour Plan to see what needs to be added or changed to prevent violent incident from recurring. Plan will include goals/expectations, strategies and consequences to answer...What can we do to prevent violent behaviour from recurring and keep everyone safe?
- Principal and key staff will consider asking the Support Behaviour Team and/or the Specialized Behaviour Team for help the principal’s responses for their own records
- Teacher documents all details of what occurred and the Principal’s responses for their own records.
- Cycle continues with reporting and reviewing processes being utilized.
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If the Principal has exhausted all possible options, violent incidents continue to occur and/or it is felt a student’s behaviour continues to pose a risk to personal safety, the Union Rep or the Board’s Health and Safety Officer may be contacted.
- The Health & Safety Officer may be contacted at any time during this process.
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Definitions Referred to in Blueprint(Consistent with language in current Board policies)
Violent Incident - shall be defined as any incident in which an employee feels that he/she is threatened verbally or in writing and/or is abused, harassed or assaulted physically, emotionally, sexually, racially or ethno culturally; resulting in the impairment of health and safety of any employee or student.
Behaviour Plan - a document that is developed to set positive behavioural goals/expectations, address skill deficits, identify behavioural triggers, and recommend strategies for behavioural change and stress/anxiety reduction.
In-school Behaviour Team - Principal/Vice-Principal, Special Education/Resource Teacher, Classroom Teacher, Child and Youth Counsellor (where available), Guidance Counsellor (where available), Educational Assistant (where available). The purpose of the team is th develop strategies for assisting students with behavioural needs.
Behaviour Support Team - Includes the In-school Behaviour team with the addition of the Psychology Consultant, the Attendance Counsellor/Social Worker, and the Speech and Language Pathologist. A Special Education Consultant from Program Services may be included. The purpose of this team is to develop a plan for further evaluation of the child if needed and to make suggestions about the Behaviour Plan.
Specialized Behaviour Team - Consists of the Co-ordinators of special education, Psychology, and speech and Language, or their appointees. This team works with the Behaviour Support Behaviour Team to refine the Behaviour Plan, investigate other Board resources that may be helpful e.g; Health and Safety Officer), and to consider access to community resources.
Forms:
Incident/Accident Report (Form 4301-1) - Teachers who have been the victim of a violent incident must report the incident to the Principal or Vice-Principal and complete an Employee Incident/Accident Report (Form 4301-1). The completed form will be sent to the Board’s Joint Health and Safety Committee. The teacher may keep a photocopy for their records and send a copy to ETFO at Orchard Park.
Violent Incident Report (Form 206-1) - When Teachers or students have been the victim of a violent incident involving a student, the Principal or Vice-Principal will complete a Violent Incident Report (Form 206-1). The completed form will be signed by the Principal and the Teacher and sent to the Superintendent of Education. The teacher may keep a photocopy for their records and send a copy to ETFO at Orchard Park.
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