Crisis Response Reflection form for School Personnel

Please provide the following information. The information is kept confidential and does not go into a permanent record. Please fill out the form, print a copy for your files, and click "DONE". PLEASE PRINT YOUR OWN COPY BEFORE YOU SUBMIT THE FORM. Thank you.

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* 1. Your Name (optional):

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* 2. Your school

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* 3. Date of crisis:

Date

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* 4. Type of Crisis

Staff Death

Student Death

Other (please specify)

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* 5. Please check all services that the district crisis response team assisted with before or during the crisis:

Staff meeting

Letter or email to staff

Announcement or notification to students

Parent letter

Classroom talks with students

Support groups in care center for students

Individual or group support with staff

All of the above

Other (please specify)

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* 6. Were the services provided helpful? Check all that apply:

A = Adequate number of CRT members sent to support school.

B = CRT members responded in a timely manner.

C = CRT members met your expectations.

D = All the above

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* 7. What was the most helpful part of the response?

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* 8. How would you improve the District Crisis Response Team response?

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* 9. Do you still require any assistance?

Please print a copy of this for your own records before you submit. Thank you.