Service Restriction Form

Question 1

Service Restriction:
There is a sliding scale based on…

Answer 1

severity, frequency, and intent.

Indefinite service restrictions can be imposed for any of the behaviors listed below if necessary.

Question 2

Physical and Sexual Assault

Answer 2

deliberate action to harm; indecent exposure, intentional spitting, unwanted touching
> Deliberate: adj. purposeful, intentional, planned,
> Indecent: adj. offensive, coarse, rude, filthy

Question 3

Serious Threat of Violence

Answer 3

Stalking, Bullying, Targeting, Harassing and/or Threatening Phone Calls & Emails

Question 4

Threatening

Answer 4

Threatening Behavior/ Destroying Property/ Throwing Objects: (shaking fists, threatening looks/ posturing)

Question 5

Language

Answer 5

Abusive and/or Oppressive Language: (any discriminatory remark, oppressive language)