Attachment 2 "Protective Action Response (Par) Fidelity Request Form" - Florida

What Is Attachment 2?

This is a legal form that was released by the Florida Department of Juvenile Justice - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 17, 2018;
  • The latest edition provided by the Florida Department of Juvenile Justice;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Attachment 2 by clicking the link below or browse more documents and templates provided by the Florida Department of Juvenile Justice.

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Download Attachment 2 "Protective Action Response (Par) Fidelity Request Form" - Florida

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Protective Action Response (PAR) Fidelity Request Form
CCC Report Number: _____________
Today’s Date: __________________________
Date of Incident: _________________
Program Area:
Detention
Probation
Residential
Other
Region:
North
Central
South
Program/Facility Name: _________________________________________________________________
Program/Facility Address: _______________________________________________________________
Administrator/Program Monitor: __________________________ Email/Phone: ___________________
Regional Director: _________________________________ Email/Phone: ________________________
Type of Request (check ALL that apply):
Review of Incident
PAR Instructor Remediation
Comments/Explanation: Please specify the purpose for the PAR Fidelity Request:
Were all staff involved, PAR certified at the time of the incident?
Yes
No
Supporting Documentation:
List of staff involved
PAR Report(s)
Incident Report(s)
Video(s)
Please specify other documents provided: __________________________________________________
_____________________________________
_____________________________________________
Requestor Signature /Title
Email Address/ Phone #
For the use of the Office of Staff Development and Training
Incident assigned to: ______________________________________________________________________
Date assigned: _________________________
Assigned by: _________________________________
_______________________________
___________
____________________________
Signature of DJJ Master PAR Instructor
mm/dd/yyyy
Email Address/Phone #
Use the PAR Fidelity Monitoring Form to report findings, provide recommendations, and/or a PAR Corrective Action Plan.
May 17, 2018
Attachment 2
PAR Fidelity Request Form
Protective Action Response (PAR) Fidelity Request Form
CCC Report Number: _____________
Today’s Date: __________________________
Date of Incident: _________________
Program Area:
Detention
Probation
Residential
Other
Region:
North
Central
South
Program/Facility Name: _________________________________________________________________
Program/Facility Address: _______________________________________________________________
Administrator/Program Monitor: __________________________ Email/Phone: ___________________
Regional Director: _________________________________ Email/Phone: ________________________
Type of Request (check ALL that apply):
Review of Incident
PAR Instructor Remediation
Comments/Explanation: Please specify the purpose for the PAR Fidelity Request:
Were all staff involved, PAR certified at the time of the incident?
Yes
No
Supporting Documentation:
List of staff involved
PAR Report(s)
Incident Report(s)
Video(s)
Please specify other documents provided: __________________________________________________
_____________________________________
_____________________________________________
Requestor Signature /Title
Email Address/ Phone #
For the use of the Office of Staff Development and Training
Incident assigned to: ______________________________________________________________________
Date assigned: _________________________
Assigned by: _________________________________
_______________________________
___________
____________________________
Signature of DJJ Master PAR Instructor
mm/dd/yyyy
Email Address/Phone #
Use the PAR Fidelity Monitoring Form to report findings, provide recommendations, and/or a PAR Corrective Action Plan.
May 17, 2018
Attachment 2
PAR Fidelity Request Form