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Incident Alert

IF YOU ARE IN IMMEDIATE DANGER, CALL 911.

Petersburg City Public Schools is committed to providing students with a safe, comfortable learning environment. All incidents, including potential incidents, can be reported directly to a trusted staff member at your school. This online form may also be used by Petersburg City Public School students and families to report being bullied, to report someone witnessing a student being bullied, or other potentially threatening altercations and incidents. This form is to alert the school administration of potential incidents. Incidents will be investigated. Keep in mind, this process can only be as thorough as the information provided.

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What date did the incident (or potential incident) occur? *
MM
/
DD
/
YYYY
What time did the incident (or potential incident) occur? *
Time
:
What is the location of the incident (or potential incident)? *
What school did the incident (or potential incident) occur? *
Name(s) of the alleged offenders (optional). 
Please describe the incident (or potential incident). Try to include as many details as possible (optional).
Check all that apply.
Name (optional)
Phone (optional)
Email (optional)
Select which applies to you (optional).
By completing this form, you are verifying that your statements are true and accurate to the best of your knowledge.
*
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