Harmful or Hurtful Incident Intake Form - Blessed Sacrament
Thank you for bringing this to our attention. We need to confirm what you have shared with us by asking a few questions. This information will be given to the building investigation team.
Person Completing Intake Form *
Person Making the Report
Fill this our if different from person completing intake form. (For example a student tells a teacher and the teacher fills out the report, or a parent tells and administrator and the administrator fills out the report.)
Contact information *
Please provide a phone number or email address.
Person(s) who was allegedly harmed or hurt. *
Ask for the name(s). If the student is not sure, ask what grade, or class, or if in band, sports, etc. What lunch period - things of this nature.
Person(s) who is being accused of harm or hurt. *
Ask for the name(s). If the student is not sure, ask what grade, or class, or if in band, sports, etc. What lunch period - things of this nature.
Incident(s) - FACTS ONLY *
1) What did you hear or see? 2) Did you hear or see anything else? 3) Where did this happen? 4) Did it happen anwhere else? 5) When did this happen? 6) Did this happen at any other time? 7) What else can you think of? - Everything that you remember is imprtant.
Potential witnesses
Describe what you have done as a result of this alleged incident?
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This form was created inside of Cedar Valley Catholic Schools.