Incident Reporting Form
Do not use this form if there is an immediate threat to Students, Staff, or Buildings, instead call 911.
Contact Info: phone/e-mail/homeroom (optional)
Name of adult(s) you have already contacted (if any)
Name(s) of accused (if known)
Where did the incident happen:
Please check the item that best describes what the accused did. Please choose all that apply.
Physical; hitting, kicking, shoving, spitting, etc.
Teasing, name calling, put downs, criticizing, jokes.
Threatening in person, by phone, by e-mail, social media, etc.
Excluding or rejecting the student
Demanding money, homework, etc.
Getting another person to hit or harm the student.
Property issues (hiding, damaging, taking).
Making rude and/or threatening gestures.
Spreading harmful rumors or gossip.
Threatening physical harm to self
Weapon at school (gun, knife, etc.)
Threat against the school or staff
Describe what happened. Use exact language and as much detail as possible.
Is this report being made by a
I agree that this information is accurate and to the best of my knowledge.
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