Supervision Plan
*Asterisk denotes drop-down list
Student Information
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| Student: | Student ID: | Date: |
| School: * | Grade: * | |
Date of Implementation: *
Staff point person:
Immediate Responders:
| Additional Responders
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Communication Plan:
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| All staff in contact with the student throughout his school day will be notified of the supervision while maintaining student’s FERPA rights. Any information about student that required staff must know to maintain a safe environment will be distributed via e-mail, written notice, or during school meetings.
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Staff Response Plan:
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| Supervision plan is currently in place to support the student while at school. Should the student choose not to follow the parameters of this supervision plan, intervention will begin at the classroom level by their immediate teacher. Student is responsible for attending all class periods on time. Any absence will require immediate notification to the main office. If the safety of the student has been compromised, staff will immediately notify immediate responders listed above. Once the incident has been properly assessed, administration and the response team will take the necessary steps to ensure the student’s safety. |
Transition Supervision:
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Activity:
| Specific Details:
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| * | |
| * | |
| * | |
| * | |
Notification Plan
Where and when appropriate as per FERPA, state law and collective bargaining agreement. Include classified staff, clerical, custodial, food service, etc. as appropriate: | |
Immediate staff
| Principal, assistant principal(s), counselor, teacher(s), security, secretaries, nurse, health room assistant |
Peripheral staff
| Consider: school psychologist, paraprofessional, social worker, IEP case manager |
Substitute Notification:
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Guest teacher
| Substitute plans will include reference to the safety plan and school administration or appropriate staff will share appropriate information |
Guest Paraprofessional
| Substitute plans well include reference to the plan and refer the staff member to school administration or appropriate staff for additional information |
Notification in case of emergency:
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| All communications should be directed to student’s staff point person. If the student is to leave campus during the school day and all adult supervisors and school administrators will immediately be notified. School administrator will determine appropriate notification is made dependent upon the situation. | ||
| Name: | Phone Number: | |
| Parent/Guardian: | ||
| Parent/Guardian: | ||