Harassment, Intimidation Or Bullying - Targeted Student Safety Plan Template printable pdf download

Harassment, Intimidation or Bullying - Targeted Student Safety Plan Template

Definitions & Guidance:

Our school provides a safe and secure learning environment that is free from of harassment,

intimidation or bullying (HIB). Especially vulnerable students who have been the alleged targets of HIB

may need special protection to ensure their emotional and physical safety is secure during investigations

and/or after sanctions have been imposed on aggressor students.

This safety plan template raises key issues for you to consider to assist in the protection of a vulnerable

student and in the writing of a safety plan. It is understood that each situation is different and that

additional considerations may be included.

It is recommended that this Student Safety Plan be completed by the school’s existing safety, discipline

or student support team. Examples of such groups include a school’s Care Team, Student Intervention

Team (SIT), 504 Implementation Team, Multidisciplinary Intervention Team (MDT), or HIB Prevention-

Intervention Team. It is also recommended that the targeted student and a member of the targeted

student’s family be involved in the development of the plan. Once the plan has been developed by the

team, the principal or his/her designee will see that it is implemented with the student and his/her

SAMPLE

family. The principal will also share this plan with all necessary school staff. The classroom teachers will

leave a copy of the plan for any substitute teachers who come in.

The plan involves two components: the actions school staff will engage in and the actions the student

will engage in. The plan has a definite start and a proposed end date. It is meant to cover the entire

school day, from the time a student boards a bus in the morning until he/she departs the bus at the end

of the day. The targeted student needs to be safe during before-school and after-school activities, and

protected from any new bullying done by others in support of the initial aggressor or in retaliation for

reporting or discipline actions.

The plan designates a Primary Staff Contact for the targeted student. This person might be the staff

person to whom the student first reported the HIB, or with whom the student feels most comfortable.

It might also be his/her homeroom teacher, counselor or another classroom teacher.

It is the intent of this plan that it be carried out in a way which is minimally intrusive. School layout,

passing times, grade levels and configurations and availability of staff may impact the plan. It will be

necessary to adapted to the building. For example, if there are locations which are known to be

particularly dangerous for the student, those areas need to be identified and monitored. (An additional

template is available which more closely fit the needs of primary grades.)

HIB Targeted Student Safety Plan Template

Harassment, Intimidation Or Bullying - Targeted Student Safety Plan Template