To submit this form, ensure all fields are accurately filled out. You can either email the document to [insert email], fax it to [insert fax number], or submit it through the designated online portal. Physical copies can be sent to [insert physical address]. It is advised to keep a copy of the submitted form for your records.

Important dates for the Incident Action Plan in 2024 include annual educational reviews in January and July. In 2025, all program assessments must be submitted by March for state compliance. Stay updated with these key timelines to ensure proper adherence.

The purpose of this form is to create a clear and comprehensive record of behavioral incidents within educational settings. It serves as a means of communication between educators, parents, and administrators regarding children's behavior. By documenting these incidents, the form aids in identifying patterns and developing strategies for improvement and support.

• 1. Child's Name: Allows entry of the child's full name.
• 2. Date of Incident: Captures the specific date the incident occurred.
• 3. Time of Incident: Records the precise time of the incident.
• 4. Description of Incident: Detailed account of what happened during the incident.
• 5. Previous Occurrences: Inquires if this is a repeated incident and when it last occurred.
• 6. Additional Services: Indicates if the child is receiving any special services.
• 7. Changes in Routine: Requests information on any unusual circumstances that may have influenced behavior.
• 8. Preventive Actions: Details any measures that could prevent future incidents.
• 9. Immediate Actions: Notes what actions were taken by the educator just before the incident.
• 10. Response to Intervention: Evaluates how the child reacted to the educator's response.
• 11. Incident Outcome: Describes the results of the incident, including injuries or damage.
• 12. Emergency Response: Details if emergency services were contacted.
• 13. Parent Notification: Identifies who notified the parent and the method used.
• 14. Meeting Schedule: Indicates if a meeting with the parent was scheduled.
• 15. Meeting Details: Records the date, time, and attendees of the meeting.
• 16. Referral Status: Notes if a referral was made with parental consent.
• 17. Plan Development: Outlines the plan created collaboratively with the parents.
• 18. Signatures: Captures the signatures of involved staff and parents.

Failing to submit this form can lead to a lack of documentation regarding a child's behavioral issues. This may affect the child's eligibility for support services and hinder proper communication with parents and caregivers. Incidents may go unaddressed, leading to recurring problems in the educational setting.

• Lack of Documentation: Without proper submission, incidents may not be recorded.
• Reduced Support: The child may not receive necessary interventions.
• Parental Communication Breakdowns: Failure to inform parents can create misunderstandings.

• 1. Behavioral Incidents: Use this form to document any significant behavioral events.
• 2. Accidents: Record details surrounding any accidents occurring in the facility.
• 3. Property Damage: Indicate instances of property destruction by the child.