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SCCS Incident Report Form
SCCS believes that everyone has the right to attend school in an environment that is safe, respectful, responsible, and kind.

This form is just one of many ways that students can report alleged incidents that need the attention of a counselor or principal at SCCS. An example of an incident could be mistreatment, threats (threatening statements, comments, social media posts, etc.), theft, vaping/drug or alcohol violations, and/or concerns for another student’s mental health and/or well-being. Reporting of an incident can take place face to face, in writing, or via this form.

School policy prohibits discrimination against students by students and/or employees on school property or at a school function based upon a person’s actual or perceived, color, weight (physical appearance), disability (physical, intellectual), ethnic group, national origin, race, sexual orientation, sex, gender (including gender identity or expression/transgender), religion and/or religious practice, socio-economic status, and/or academic status.

If you ever feel that you are a victim or if you witness or obtain knowledge of a possible offense and/or are mistreated by another student(s) or staff member, there are several things you can do to report the incident and receive resolution to a concern. It is the responsibility of all SCCS students and staff/faculty to report incidents of improper behaviors. Violation to the SCCS code of conduct will result in behavioral consequences.

In serious and/or repeated cases, a DASA investigation may be completed by the SCCS DASA coordinator. For more information on DASA please go to the following website... Mr. VanHall is the DASA coordinator for SCCS.

When reporting an issue you may...
 Talk to a school administrator/staff member about an issue

 If you are comfortable and where appropriate, you may speak with the other person involved to resolve the issue.
    If you are uncomfortable or are not sure how to handle the issue, you can do one or more of the following:
o Seek out a trusted staff member, counselor, or administrator for assistance;
o Talk to your parents about the incident and seek their advice;
o E-mail your concerns to a counselor or administrator;
o Complete the information below or pick up a form in the main office and submit form directly to HS Office secretary

Upon submission, this form will be sent to SCCS principals & counselors at your school  
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Your Name
Other Students Name *
Date *
Issue/Incident (please explain) *
What was your involvement in the incident? *
To your knowledge, has this incident occurred in the past?
I certify that all statements on this form are accurate and true to the best of my knowledge. *
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