Pearsall ISD Safety Tip Line (Incident Report Form)
Please use this form to submit information regarding any safety issues, including but not limited to bullying, threats, violence, drugs, risky behavior, etc. All data reported on this form is sent directly to a District administrator.

You have the ability to submit the form with your contact information or remain anonymous. Please include as much detail as possible so that we can assist you.

If your message is urgent contact your child’s school directly.

Campus *
Today's Date *
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Alleged Targeted Student(s) Information (i.e. name, grade level, ID #, etc.) *
“Targeted Student” means the student who is the victim of the bullying or harassing behaviors
Your answer
Alleged Aggressor(s) Information (i.e. name, grade level, ID #, etc.) *
“Aggressor” means the student who exhibits the bullying or harassing behaviors
Your answer
First and Last Name(s) of Witness(es) to Incident *
Your answer
Date of Incident *
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Approximate Time of Incident *
Time
:
Where did the safety incident take place? *
Other Location Details:
Please explain the specific location details such as which hallway, which classroom, which social media site, which restroom, which bus, etc.
Your answer
What type of safety incident occurred? *
Describe what happened with as many details as possible. *
Your answer
Do you believe that the aggressor has any control over the targeted student? *
If yes, how so?
Your answer
Was incident ever reported to anyone else? *
If yes, to whom, when and what was done?
Your answer
Person Reporting the Incident
OPTIONAL (Please use your full name)
Your answer
May we contact you for more information on this incident?
Contact Information
Your answer
Thank you for reporting this incident. We appreciate your concern. When you click "Submit" this will be sent to a District administrator.
Submit
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