JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Incident Reporting for 25-26 /
Informe de incidentes para 25-26
Use this form to report an incident to our principal and counseling team.
Utilice este formulario para informar un incidente a los directores y counsejeros.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Your First Name
Nombre
*
Your answer
Last Name
Apellido
*
Your answer
Grade
Grado
*
Choose
6
7
8
Parent or Guardian Name
Nombre de padre/s o guardián
Your answer
Who asked you to report the incident?
¿Quién le pidió que denunciara el incidente?
Your answer
Who are you reporting?
¿A quién estás denunciando?
*
Your answer
Where did this happen?
¿Donde pasó esto?
*
Choose
Off Campus / Fuera de la propiedad escolar
Classroom / Aula
Restroom / Baño
Hallway / Pasillo
Gym / Gimnasia
Auditorium / Sala
Lunchroom / Comedor
Playground / Recess; recreo
School Bus / Autobús escolar
Other / Otro
Date of incident
Fecha de incidente
*
Your answer
Time of incident
Hora de incidente
*
Your answer
What type of incident do YOU think this is?
¿Qué tipo de incidente crees que es?
*
Harassment / Acoso
Bullying / Cyber Bullying; Bullying / Ciberbullying
Threat / Amenaza
Inappropriate Language or Gestures / Lenguaje o gestos inapropiados
Physical Aggression / Agresión física
Stealing / Robo
Disruptive Behavior / Comportamiento disruptivo
Inappropriate Use of Electronics / Uso inapropiado de dispositivos electrónicos
Vandalism / Vandalismo
Other / Otro
Please describe what happened
Por favor describa lo que pasó
*
Your answer
Names of witnesses who were with you
Nombres de los testigos
*
Your answer
Who was harmed by what happened?
¿Quién resultó perjudicado por lo ocurrido?
*
Your answer
What have you already done to address this?
¿Qué has hecho ya para solucionar esto?
*
Your answer
What do you think about what happened?
¿Qué opinas de lo ocurrido?
*
Your answer
What do you think needs to happen to make this right?
¿Qué cree usted que debe suceder para solucionar esto?
*
Your answer
Would you agree to meet with the person you are reporting and an adult to work this out?
¿Estaría usted de acuerdo en reunirse con la persona que está denunciando y un adulto para resolver esto?
*
Yes / Sí
No
Maybe / Tal vez
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Park City School District.
Does this form look suspicious?
Report
Forms
Help and feedback
Help Forms improve
Report