Standards › Standard 1 › Forms
Form · CLN-FRM-004 · Version 1.0 · Approved by the ASF Expert Committee
Supports: 1.4
Purpose
Records each use of restraint or seclusion: the reason, the less restrictive options, the order, the monitoring and the release.
How to complete
- Complete at the start of each use.
- Record each monitoring check.
- Record the release time.
Record fields
| Patient ID | Type (physical, chemical, seclusion) | Reason | Less restrictive options tried | Order and time limit | Monitoring checks | Release time |
|---|---|---|---|---|---|---|
Evidence
| Reference | Note |
|---|---|
| E-009 | ASF Expert Committee consensus. |
| E-006 | ASF Policy Framework v1.2. Adapted. |
| E-009 | ASF Expert Committee consensus. |
Change history
| Version | Date | What changed | Approval |
|---|---|---|---|
| 1.0 | the date of approval | First version | set Expert Committee approval |
E-learning for this document
- Slip, Trip & Fall Prevention (FALL-01)
- Patient Identification, Informed Consent and Patient Rights (T-07)
- Care & Treatment: Clinical Standards for Accreditation (H-04)
Planned course: Hospital falls prevention, based on the falls guideline. New course planned.
References
- Accréditation Sans Frontières (2026). ASF Policy Framework v1.2. (E-006)
- Accréditation Sans Frontières (2026). ASF Expert Committee consensus on Standard 1. (E-009)