Request edit access
ER9 Incident Report Form 2019-2020
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:
Joseph Amodio, Redding Elementary School
Darlene Wallin, John Read Middle School, ER9 Coordinator
Michael Brownstein, Samuel Staples Elementary School
Annie Mohr, Helen Keller Middle School
Jennifer Desmarais, Joel Barlow High School - Grades 9 & 12
Julie McTague, Joel Barlow High School - Grades 10 & 11
Never submit passwords through Google Forms.
This form was created inside of Easton Redding Region 9 Public Schools.