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Person initiating seclusion and/or restraint; others present/involved: Describe the behavior that led to seclusion and/or restraint, including time, location, activity, others present, other contributing factors: Time and Location: Activity: Others Present: Contributing factors: Procedures used to attempt to de-escalate the student prior to using seclusion and/or restraint: Describe student behavior during seclusion and/or restraint: Was there any injury or damage? If yes, describe: Yes.

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