Gallatin High School Incident Report

Name of person completing the report: ________________________________ Date: _________

Type of incident (i.e. fight, theft, harassment, etc.) _____________________________________

Date of incident: _______________ Location of incident: _______________________________

Report of incident: ______________________________________________________________

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The facts in this statement are true to the best of my ability:

Signature: ____________________________________________ Date: ___________________

Statement Received by: __________________________________________________________