HIB-Targeted Student Safety Plan - Student Safety Plan Template Definitions & Guidance

Sep 23, 2026

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HIB-Targeted Student Safety Plan Template Definitions & Guidance outlines how a school should protect students who are alleged targets of harassment, intimidation, or bullying during investigations and after sanctions. It recommends completing the plan with existing safety, discipline, or student support teams, and involving the targeted student and a family member. The plan covers the full school day, assigns a Primary Staff Contact, sets procedures for staff, classroom separation, recess monitoring, and bus intervention, and defines responsibilities for targeted student reporting and parent/family monitoring.

LanguageEnglish

CategoryForms

FormatPDF

Pages4

Reading Time2 min

AccessFree to download

HIB Targeted Student Safety Plan Template

Student Safety Plan Overview and Team Involvement

Primary Staff Contact and Plan Coverage

A. School/Staff Actions

B. The Targeted Student Actions

Parents/Family Agreement and Review

Harassment, Intimidation or Bullying-Targeted Student Safety Plan Template Definitions & Guidance: Our school provides a safe and secure learning environment that is free from harassment, intimidation or bullying ( HI B). Especially vulnerable students who have been the alleged targets of HI B may need special protection to ensure their emotional and physical safety is secure during investigations and/or after sanctions have been imposed on aggressor students. This safety plan template raises key issues for you to consider assisting in the protection of a vulnerable student and in the writing of a safety plan. It is understood that each situation is different and that additional considerations may be included. It is recommended that this Student Safety Plan be completed by the school’s existing safety, discipline or student support team. Examples of such groups include a school’s Care Team, Student Intervention Team (SIT), 504 Implementation Team, Multidisciplinary Intervention Team ( MDT), or HI B Prevention-Intervention Team. It is also recommended that the targeted student and a member of the targeted student’s family be involved in the development of the plan. Once the team, the principal, has developed the plan or his /her designee will see that, it is implemented with the student and his/her family. The principal will also share this plan with all necessary school staff. The classroom teachers will leave a copy of the plan for any substitute teachers who come in. The plan involves two components: the actions school staff will engage in and the actions the student will engage in. The plan has a definite start and a proposed end date. It is meant to cover the entire school day, from the time a student boards a bus in the morning until he/she departs the bus at the end of the day. The targeted student needs to be safe during before-school and after-school activities, and protected from any new bullying done by others in support of the initial aggressor or in retaliation for reporting or discipline actions. The plan designates a Primary Staff Contact for the targeted student. This person might be the staff person to whom the student first reported the HI B, or with whom the student feels most comfortable. It might also be his/her homeroom teacher, counselor or another classroom teacher. It is the intent of this plan that it be carried out in a way that is minimally intrusive. School layout, passing times, grade levels and configurations and availability of staff may impact the plan. It will be necessary to adapted to the building. For example, if there are locations that are known to be particularly dangerous for the student, those areas need to be identified and monitored. (An additional template is available which more closely fit the needs of primary grades. ) 1 HIB Targeted Student Safety Plan Template HI B-Targeted Student Safety Plan Student’s Name: Primary Staff Contact: Classroom/ Homeroom Teacher: Grade Level: Room Number: Plan start date: Proposed End date: A. School/Staff: 1. ❑All school staff will be apprised of this safety plan and will make every effort to implement it successfully. 2. ❑Any school staff who witness or are otherwise made aware of any harassing, intimidating or bullying behavior directed toward the student will intervene immediately and will report such behavior to the principal. 3. Classroom and Passing Times: ❑ will be designated as the student‘s primary point of contact (trusted adult) on staff. ❑, the classroom teacher, will keep the student and his/her aggressor separated in the classroom and during class activities when possible. ❑Other classroom teachers (specialists) will do their best to keep the student and his/her aggressor separated in the classroom and during class activities. ❑ are designated as the student’s recess monitor and will be visible and available during recess. 4. ❑ will check in with the student on a daily basis

FAQs

Who should complete and implement the HIB targeted student safety plan?

The plan is recommended to be completed by the school’s existing safety, discipline, or student support team, such as a Care Team or Student Intervention Team. The principal (or designee) ensures implementation with the student and family, and shares it with necessary school staff.

What does the plan cover regarding time and supervision?

The plan is intended to cover the entire school day, from when the student boards a bus in the morning until leaving the bus at the end of the day. It includes protection before-school and after-school activities as well as monitoring to prevent new bullying related to the initial incident.

What responsibilities are assigned to the primary staff contact and school staff?

A Primary Staff Contact is designated based on the student’s initial report or comfort level. School staff are expected to be apprised of the plan, intervene immediately if they witness bullying, keep the student and aggressor separated when possible, monitor recess, perform daily check-ins, and have the bus driver report incidents to the principal.

What are the responsibilities of the targeted student and family under the plan?

The student should avoid face-to-face or online contact with the aggressor unless monitored by an informed adult, identify safe friends, stay close to trusted friends as reasonable, and report breaches immediately to parents or designated trusted adults and staff. Parents and family members agree to monitor and support the student, monitor technology use, and contact the school if problems persist or escalate so the team can review and update the plan.

Sep 23, 2026

Upload by Fahsai