Request edit access
ER9 Incident Report Form 2020-2021
As members of the Easton, Redding, and Joel Barlow communities we make it a priority to care for ourselves, our community, and our world. If you have any information that can be used to keep a classmate, friend, or community member safe from mean behaviors, self-harm, and/or drug involvement, please fill out this form. Complete the prompts that apply to the situation. Leave the others blank.
Name (optional): All anonymous complaints will be investigated. However, please note that no disciplinary action shall be taken solely on the basis of an anonymous complaint.
Email address (optional):
Role of the person making the report (student, parent, teacher, etc.):
The name of the student who is experiencing or is the target of mean or harmful behavior(s): *
The name of the student being reported as committing the mean or harmful act: *
Date, time, and place of the mean/unsafe behavior(s): *
Description of the incident: *
Name(s) of witness(es):
Any additional information that you think will help us understand the incident:
Select the School Climate Specialist who will be responding to this incident: *
Submit
Never submit passwords through Google Forms.
This form was created inside of Easton Redding Region 9 Public Schools. Report Abuse