Florida School Toolkit for K-12 Educators to Prevent Suicide

Assessed Level of Risk: Low: Medium: High: Time: Student: Grade: School: Risk Assessment Completed by: Part 1—Complete in All Cases (Low–High Risk) Action Yes/No Date|Time Notes Initial assessment (Tool 14a or 14b, completed with student) Safety plan (Tool 17, completed with student) Student counselor notified Designated administrator notified Teacher(s) notified Suicide response designee named Parents notified about child's suicidal ideation Parent(s) signed parent notification form (Tool 18; if no, note witness to refusal) Parent(s) signed information release section of same (Tool 18; if no, note witness to refusal) Notification steps and community referrals activated (Tool 19) Part 2—Complete if Necessary (Medium–High Risk) Action Yes/No Date|Time Notes Supervisor appointed to remain with student at all times (including restroom) Student released to a) parent or guardian, b) law enforcement, or c) psychiatric mobile crisis unit (note circumstances) Florida Dept. of Children and Families notified (note circumstances) Check to confirm copy provided to student’s counselor, suicide response designee, and administrator. TOOL 16 Suicide Risk Report 81