Section 1 of 1
VIOLENCE
REPORTING FORM (Suspicion or Witness Statement)
My
full name and class:
My
full name and class:
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
I
would like to report a suspicion or provide a witness statement regarding
violent behavior directed towards (full name and class):
I
would like to report a suspicion or provide a witness statement regarding
violent behavior directed towards (full name and class):
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Brief
description of the incident involving violence:
Brief
description of the incident involving violence:
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Persons
whom I believe are involved in the inappropriate behavior:
Persons
whom I believe are involved in the inappropriate behavior:
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
The
described incident occurred or is occurring in the following location:
The
described incident occurred or is occurring in the following location:
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
School Yard
Hallway
Classroom
Other:
Add option
…
Answer key
(0 points)
Loading...
The
described incident occurred or is occurring on the following date (or period):
The
described incident occurred or is occurring on the following date (or period):
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
The
following persons were also involved in the incident (and please describe how):
The
following persons were also involved in the incident (and please describe how):
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Link to Sheets
Summary
Question
Individual
Insights
Total points distribution
Loading...
Settings
Responses
Manage how responses are collected and protected
Presentation
Manage how the form and responses are presented
Defaults
Form defaults
Settings applied to this form and new forms
Question defaults
Settings applied to all new questions