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Incident Reporting Form
This form can be completed anonymously but be aware that may limit our ability to respond.
This form is intended for the use of any persons affiliated with Sharon Public Schools to report any instances of harassment, bullying, assault, discrimination, aggressions, cyber bullying, intimidation, theft, drug and alcohol abuse, and/or sexual and gender-based misconduct. This form is to be given to any school staff member who will use the information to conduct an investigation into the matter.
Today's Date *
Your answer
Name of Individual(s) reporting:
Your answer
Role of Individual(s) reporting (individual harmed, witness, support person, etc):
Your answer
Name of person (s) harmed:
Your answer
Grade/Position/School:
Your answer
Date of incident (s): *
MM
/
DD
/
YYYY
Time of incident (s):
Time
:
Type of incident (s): *
Required
Name of perpetrator(s) [if known]:
Your answer
Grade/Position/School:
Your answer
Incident location: *
Required
Briefly describe the incident (s) and /or your concern. Use reverse side if necessary: *
Your answer
Form may also be printed out and returned to any trusted school staff, at any school main office, or send to:
Sharon Public Schools
Attn: Title IX Director
75 Mountain St
Sharon, MA 02067
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