Restraint Injury Report
Introduction
This report will generate the Student/Staff Restraint Injury Report required by 603 CMR 46.06(7) to be submitted within three (3) school working days of the restraint occurrence to the Director of Program Quality Assurance Services, Massachusetts Department of Elementary and Secondary Education when a student or staff member is injured during the physical restraint of a student. The data for this report is extracted from the Log table where the Log Type = Restraint and the Injury box is checked indicating an injury occurred during the application of the physical restraint. If you will be including a 30-day log of restraints that meets the log requirements specified in 603 CMR 46.06(2), be sure to indicate this in the report paramenter section below.
Selection Criteria
Selection criteria determine which database records are used in the report. Refer to selection criteria for analysis when the report does not return the correct records.
- Student not excluded from state reporting.
- School not excluded from state reporting.
- Restraint Log Record not excluded from state reporting.
- Restraint Log Record with Person(s) injured.
Note: Restraint Injury Logs within (inclusive) the Start Date and End Date will be extracted.
Report Input
For help with navigation and running the report, see How to Find and Generate a Report.
Field | Description |
Select Schools | If run at the district level, choose one of the following:
If run at the school level, the report includes all records associated with the current school that meet the selection criteria. To change the current school, click School at the top of the page and choose the appropriate school from the list. |
Select Students* | Indicate which students to include in the report by selecting one of the following options:
Note: If running the report for a single student, or group of students, select the students prior to running the report. |
Report State Date* | Enter the report start date. |
Report End Date* | Enter the report end date. |
Include Logs created in District Office* | Choose Yes or No to indicate whether or not to include Restraint Injury Logs created in the District Office. |
Logs required by 603 CMR 46.06(2) will be submitted with this report* | Choose Yes or No to indicate whether or not to include Logs required by 603 CMR 46.06(2). |
Processing Options | Choose a time to run the report from the pop-up menu:
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Specific Date/Time | Enter a date using the format mm/dd/yyyyor mm-dd-yyyyin order to run the report on a specific day. The incorrect format displays an alert and the date field is submitted as a blank entry. Use the pop-up menus to schedule the report to be run at a specific hour and minute. Example: 7/29/2008 @ 10:05 AM. |
Report Output
Data Element | Description | [Table]FieldName | Field Type | Field Length |
Name of School District, Charter School, Educational Collaborative or Approved Private Special Education Program | The state assigned LEA ID assigned to this district. | [S_MA_LOG_Restraint_X]OODAgencyName or [Prefs]Value where [Prefs]Name = DistrictName | Alpha-numeric | |
Name of School | The name of the school where the restraint injury took place. | [Schools]Name if log created at school or [Prefs]Value where [Prefs]Name = DistrictName if log created at district | Alpha-numeric | 60 |
Address | The address of the school or district depending on where the log was created. | [Schools]Address, [Schools]City, [Schools]schoolState, [Schools]schoolZip if created at school [Prefs]districtaddress, [Prefs]districtcity, [Prefs]districtstate, [Prefs]districtzip if created at district | Alpha-numeric | |
Name(s) of Injured | The names of the staff and/or student injured. | [S_MA_LOG_Restraint_X]personInjuredType=1 (Student), 2 (Staff), 3 (Both) [S_MA_LOG_RestraintPersonRole_C]personLastFirst where [S_MA_LOG_RestraintPersonRole_C]personrole=2 | Alpha-numeric | |
Name of Student Restrained | The student’s name. Note: If populated, the student's legal name overrides the student's preferred name. | Concatenate [StudentCoreFields]PSCore_Legal_First_Name, [StudentCoreFields]PSCore_Legal_Middle_Name,[StudentCoreFields]PSCore_Legal_Last_Name OR [Students]LastFirst OR concatenate [Students]First_Name, [S_MA_STU_Demographic_X]LongMiddleName or [Students]Middle_Name, [Students]Last_Name | Alpha-numeric | 130 |
Date of Restraint | The date the student was restrained. | [S_MA_LOG_Restraint_X] RestraintDate Or [Log]entry_date | Alpha-numeric | 10 |
Student Date of Birth | The student’s date of birth. | [Students]dob | Alpha-numeric | 10 |
Age | The student’s age. | Calculated | Alpha-numeric | 2 |
Gender | The student’s gender. Note: If populated, the student's legal gender overrides the student's preferred gender. | [StudentCoreFields]PSCore_Legal_Gender [Students]Gender [S_MA_STU_Demographic_X]NonBinary_Gender_TF | Alpha-numeric | 1 |
Grade Level | The student’s grade level. | [Students]Grade_Level | Alpha-numeric | 2 |
Does student currently receive special education services? | Indication if the student currently receives special education services. | [S_MA_LOG_Restraint_X]IEPIND=1 (Yes), 0 (No) | Alpha-numeric | 1 |
Date of this report | The report run date. | mm/dd/yyyy HH24:MI:SS | Alpha-numeric | 20 |
Specific location of Restraint | The location where the restraint took place. | [Schools]Name if log created at school or [Prefs]Value where [Prefs]Name = DistrictName if log created at district and [S_MA_LOG_Restraint_X]restraintSite | Alpha-numeric | N/A |
This report prepared by: | The name of the person completing the form. | [S_MA_LOG_Restraint_X] PersonCompletingFormName | Numeric | 100 |
Position | The title of the person completing the form. | [S_MA_LOG_Restraint_X] PersonCompletingFormTitle | ||
Address | The address of the school or district depending on where the log was created. | [Schools]Address, [Schools]City, [Schools]schoolState, [Schools]schoolZip if created at school [Prefs]districtaddress, [Prefs]districtcity, [Prefs]districtstate, [Prefs]districtzip if created at district | Alpha-numeric | |
Telephone | The telephone of the school or district depending on where the log was created. | [Schools]schoolPhone Or [Prefs]districtPhone | Alpha-numeric | 10 |
Person 1 Involved: Name | The name of the first person listed as involved in administering the restraint. Note: The person involved information is pulled from the information entered into the People Involved section of Student Setup - Log Entries > Massachusetts State Information (Log Type = Restraint). | [S_MA_LOG_RestraintPersonRole_C] PersonLastFirst where [S_MA_LOG_RestraintPersonRole_C] PersonRole = 3 (Person Involved in Administering Restraint) | Alpha-numeric | 100 |
Person 1 Involved: Title | The title of the first person listed as involved in administering the restraint. | [S_MA_LOG_RestraintPersonRole_C] PersonTitle where [S_MA_LOG_RestraintPersonRole_C] PersonRole = 3 (Person Involved in Administering Restraint) | Alpha-numeric | 50 |
Person 2 Involved: Name | The name of the second person listed as involved in administering the restraint. Note: The person involved information is pulled from the information entered into the People Involved section of Student Setup - Log Entries > Massachusetts State Information (Log Type = Restraint). | [S_MA_LOG_RestraintPersonRole_C] PersonLastFirst where [S_MA_LOG_RestraintPersonRole_C] PersonRole = 3 (Person Involved in Administering Restraint) | Alpha-numeric | 100 |
Person 2 Involved: Title | The title of the second person listed as involved in administering the restraint. | [S_MA_LOG_RestraintPersonRole_C] PersonTitle where [S_MA_LOG_RestraintPersonRole_C] PersonRole = 3 (Person Involved in Administering Restraint) | Alpha-numeric | 50 |
Person: 3 Involved: Name | The name of the third person listed as involved in administering the restraint. Note: The person involved information is pulled from the information entered into the People Involved section of Student Setup - Log Entries > Massachusetts State Information (Log Type = Restraint). | [S_MA_LOG_RestraintPersonRole_C] PersonLastFirst where [S_MA_LOG_RestraintPersonRole_C] PersonRole = 3 (Person Involved in Administering Restraint) | Alpha-numeric | 100 |
Person 3 Involved: Title | The title of the third person listed as involved in administering the restraint. | [S_MA_LOG_RestraintPersonRole_C] PersonTitle where [S_MA_LOG_RestraintPersonRole_C] PersonRole = 3 (Person Involved in Administering Restraint) | Alpha-numeric | 50 |
Restraint prevention/Behavior Support | Indication if the staff person administering restraint has restraint prevention training. | [S_MA_LOG_Restraint_X]hasRestraintPreventionTraining=1 (Yes), Null or 0 (No) | Alpha-numeric | 1 |
In-Depth Restraint administration | Indication if the staff person administering restraint has | [S_MA_LOG_Restraint_X]hasInDepthRestraintTraining=1 (Yes), Null or 0 (No) | Alpha-numeric | 1 |
Name of restraint methodology: | The type of hold used on the student. | [S_MA_LOG_Restraint_X] HoldUsed | Alpha-numeric | N/A |
Observers: Name | The name of the observer. Note: The observer information is pulled from the information entered into the People Involved section of Student Setup - Log Entries > Massachusetts State Information (Log Type = Restraint). | [S_MA_LOG_RestraintPersonRole_C] PersonLastFirst where [S_MA_LOG_RestraintPersonRole_C] PersonRole = 1 (Observer) | Alpha-numeric | 100 |
Observer: Title | The title of the observer. | [S_MA_LOG_RestraintPersonRole_C] PersonTitle where [S_MA_LOG_RestraintPersonRole_C] PersonRole = 1 (Observer) | Alpha-numeric | 50 |
Administrator Notification: Name | The name of the administrator who was informed following the restraint. | [S_MA_LOG_Restraint_X]adminInformedName | Alpha-numeric | 100 |
Administrator Notification: Title | The title of the administrator who was informed following the restraint. | [S_MA_LOG_Restraint_X] adminInformedTitle | Alpha-numeric | 50 |
Reported by: Name | The name of the person who verbally reported the restraint. | [S_MA_LOG_Restraint_X]verbalReporterName | Alpha-numeric | 100 |
Reported by: Title | The title of the person who verbally reported the restraint. | [S_MA_LOG_Restraint_X] verbalReporterTitle | Alpha-numeric | 50 |
Date of verbal notification | The date the administrator was informed the restraint verbally. | [S_MA_LOG_Restraint_X] adminInformedVerbalNotifyDate | ||
Date of written notification | The date the administrator received written notification of the restraint. | [S_MA_LOG_Restraint_X] adminInformedWrittenNotifyDate | ||
Description of Injuries | A description of the nature and extent of any injuries sustained, the medical care provided and any follow-up medical attention which may be needed. | [S_MA_LOG_Restraint_X] InjuryDescription | Alpha-numeric | 500 |
Precipitating Activity | A description of the activity that the restrained student, or others involved, were engaged in prior to use of physical restraint. | [S_MA_LOG_Restraint_X] AntecedentActivity | Alpha-numeric | 500 |
Behavior that prompted and justified the restraint: | A description of the student’s behavior that justified the use of restraint. | [S_MA_LOG_Restraint_X] JustifyingBehavior | Alpha-numeric | 500 |
Thorough description or efforts made to prevent escalation of behavior and alternatives to restraint that were attempted: | A description of any alternative or de-escalation techniques used or attempted to try to prevent the escalation of the situation. | [S_MA_LOG_Restraint_X] DeescalationTechnique | Alpha-numeric | 500 |
Description of Physical Restraint: | Justification for initiating physical restraint (check all that apply):
| [S_MA_LOG_RestraintJustify_C]JustifyCode=1 Or [S_MA_LOG_RestraintJustify_C]JustifyCode=2 Or [S_MA_LOG_RestraintJustify_C]JustifyCode=3 | ||
Describe holds used: | A description of why the restraint hold was chosen. | [S_MA_LOG_Restraint_X] ChosenHoldExplanation | Alpha-numeric | 500 |
Student’s behavior and reaction during restraint: | A description of the student’s behavior and reactions during the restraint, how the restraint ended, and how the student’s well-being was monitored. | [S_MA_LOG_Restraint_X] DemeanorDescription | Alpha-numeric | 500 |
Time restraint began: | The time that the restraint started. | Parsed from: [S_MA_LOG_Restraint_X] RestraintStartTime | Alpha-numeric | 2 |
Time restraint ended: | The hour that the restraint ended. | Parsed from: [S_MA_LOG_Restraint_X] RestraintEndTime | Alpha-numeric | 2 |
If restraint lasted more than 20 min, name of administrator who approved continuation of restraint: | The name of the person informed or the person who approved the extended restraint time if the restraint was applied for more than 20 minutes. | [S_MA_LOG_Restraint_X] ExtendedTimeApproverName | Alpha-numeric | 100 |
Additional restraints/Other information: | The description of additional restraints used or other pertinent information. | [S_MA_LOG_Restraint_X]injOtherInfoOrRestraint | Alpha-numeric | 500 |
Cessation of Restraint: | How restraint ended (check all that apply):
| [S_MA_LOG_RestraintCessation_C] cessationCode=1 [S_MA_LOG_RestraintCessation_C] cessationCode=2 [S_MA_LOG_RestraintCessation_C] cessationCode=3 [S_MA_LOG_RestraintCessation_C] cessationCode=4 [S_MA_LOG_RestraintCessation_C]cessationDescription if [S_MA_LOG_RestraintCessation_C] cessationCode=0 | ||
Further Action to be Taken: | The school will take the following action and/or disciplinary sanctions (check as many as apply):
| [S_MA_LOG_RestraintFutureAct_C] futureActionCode=1 [S_MA_LOG_RestraintFutureAct_C] futureActionCode=2 [S_MA_LOG_RestraintFutureAct_C] futureActionCode=3 [S_MA_LOG_RestraintFutureAct_C] futureActionCode=4 [S_MA_LOG_RestraintFutureAct_C] futureAction4Description if applicable [S_MA_LOG_RestraintFutureAct_C] futureActionCode=5 [S_MA_LOG_RestraintFutureAct_C] futureAction5Description if applicable [S_MA_LOG_RestraintFutureAct_C] futureActionCode=6 [S_MA_LOG_RestraintFutureAct_C] futureAction6Description if applicable | ||
Parent/Guardian Notification: Verbal | The date and/or description of how staff attempted to verbally inform parent/guardian of restraint use. | Derived from: [S_MA_LOG_RestraintNotify_C] NotifyDate, [S_MA_LOG_RestraintNotify_C]NotifyMethodType=1, 2, 3 where [S_MA_LOG_RestraintNotify_C] ContactType=2 (Parent/Guardian) [S_MA_LOG_RestraintNotify_C]NotifyMethodType=7,0 [S_MA_LOG_RestraintNotify_C]NotifyMethodDesc | ||
Parent/Guardian Notification: Written | Written report sent within 3 school working days of administration of restraint injury to parent/guardian on (Date) by (teacher/administrator/other) to the following address: | Derived from: [S_MA_LOG_RestraintNotify_C] ContactType=2 [S_MA_LOG_RestraintNotify_C]NotifyMethodType=4,5 [S_MA_LOG_RestraintNotify_C] NotifyDate [S_MA_LOG_RestraintNotify_C]notifieName [S_MA_LOG_RestraintNotify_C]NotifyMethodType=3,4 [S_MA_LOG_RestraintNotify_C]NotifyWrittenAddress | ||
Parent/Guardian Notification: Native Language | Indicates the written notification was sent in the parent’s native language if language is provided. | Derived from: [S_MA_LOG_RestraintNotify_C] ContactType=2 [S_MA_LOG_RestraintNotify_C]NotifyMethodType=3,4 [S_MA_LOG_RestraintNotify_C]NotifyLanguage | Alpha-numeric | |
Parent/guardian discussion: | Parent/guardian was offered the opportunity to discuss with school officials the administration of restraint and consequences that may be imposed on the student. Results of discussion (Attach separate page if necessary) | Derived from: [S_MA_LOG_RestraintNotify_C] ContactType=2 [S_MA_LOG_RestraintNotify_C]NotifyMethodType=3,4 [S_MA_LOG_RestraintNotify_C]discussionResults | Alpha-numeric | |
Copy of Log for ESE review | X if selected “Yes” on report submission page. |