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Date: __________________

Student Name: ________________________________

ID Number: __________________________________

HIA Suspension Protocol Checklist

q Suspension was determined by
q Principal/administration in consultation with behavior staff
q Special education team member consulted (when applicable)
q A discussion with the student explaining the rationale for the suspension took place
q __________________ (name of adult) had the discussion with the student
q Parents were contacted via phone on the same day the suspension was determined.
q The student was present for the phone conversation (if feasible).
q The time and date that the phone call was made was documented on the office
discipline referral (ODR) slip of the offense.
q Notation regarding if the parent was reached or if a voicemail was left was
documented on the ODR.
Notice of Suspension letter (check all that apply)
q The parent was reached via phone
q The parent was informed of the Notice, and the Notice went home with
the student.
q The Notice was mailed home.
q The parent could not be reached via phone
q The Notice went home with the student.
q The Notice was mailed home.
q The date the Notice was mailed out was recorded on the ODR.
q The Notice was mailed within 48 hours, calculated by the day the suspension was
q Provide copy to Adim TOSA
Removal (check all that apply)
q Parents were requested to pick up their student.
q The parent picked up their student; the event was documented as a
removal in the Discovery database.
q The parent could not pick up their student; the behavior staff requested
consent from the parent to send the student home on the school bus.
q The student was placed in an alternative room (this is NOT alternative instruction)
and the removal was recorded into the Discovery database
q The student maintained their regular class schedule for the day
q Other _______________________________________
Informing relevant staff members
q By the end of the school day or morning after the suspension was determined, the
behavior staff emailed all relevant staff members (i.e., classroom teacher,
specialist teacher) that the student had been removed/suspended.
q The email included the date of the student’s return from suspension.


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