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Run: Restraint Consent and Monitoring Form

Record a restraint event with consent, justification, monitoring, and release details in one audit-ready form. Use it to document what happened, why restrain...

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Event Details

Date of Event (required)

Time Restraint Began (required)

Person Identifier (required)

Use the facility identifier or record number. Do not enter unnecessary PII.

Location (required)

Type of Restraint (required)

Immediate Risk or Safety Concern (required)

Briefly describe the behavior or condition that created the need for restraint.

Consent and Authorization

Was the person able to provide informed consent at the time? (required)

Consent or Authorization Obtained (required)

Consent Method

Consent Disclosure and Explanation Provided

Confirm that the risks, purpose, and expected duration were explained using the least restrictive approach available.

Yes No N/A

Reason Consent Was Not Obtained

Least Restrictive Review

Alternatives Attempted Before Restraint (required)

Why Was This the Least Restrictive Effective Option? (required)

Supervisor Notified (required)

Monitoring Record

Monitoring Interval (Minutes) (required)

Monitoring Log (required)

Release and Review

Date of Release (required)

Time of Release (required)

Release Criteria Met (required)

Confirm the person was released when safe and clinically appropriate.

Yes No N/A

Post-Event Review / Debrief

Follow-Up Actions

Submitter and Audit Trail

Submitted By (required)

Role / Title (required)

Signature (required)

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Email (required)

Your name (optional)

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