GEA - School Safety Form

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Hello GEA Members and Other Staff:

Through our regular check-ins with members, and our own experience, the GEA leadership has become concerned about the lack of safety in some of our workspaces. It is our hope to raise this issue in a collaborative way with administration in each of the schools and at a district level. Before we do this, however, it's important for us to have a sense of the full picture.

Please take some time and review in your mind the past year. To the best of your ability, provide the information requested about any incident where you witnessed or were involved in where a student(s) or staff member(s) were threatened or made to feel unsafe in their work/study environment. We understand that dates are hard to pinpoint in the rear-view mirror, but please do your best. The GEA WILL NOT share your name or other identifying information in relation to your reporting without your explicit consent.

Please fill out the below form, one for each incident you observed or experienced. This will help us to better address these issues with the district and move to reduce the number of incidents, which are unacceptable.

This form will be linked to the GEA Website (www.gatewayeducators.org), or you can bookmark it directly to your computer. Going forward, please continue to use this form to document such incidents.

Thanks for your help and support,

~Bill Brown (on behalf of the GEA Executive Committee).

Your Name *

Grade Level (relating to the incident) *

School in which the incident took place *

Chester Elementary

Littleville Elementary

Gateway Middle School

Gateway High School

Other:

Date of Incident (as close as possible) *

YYYY

Time of incident (as close as possible) *

Time

My relationship to the incident: *

I experienced the incident directly,

I witnessed the incident

I heard about the incident 2nd hand

Please describe the incident in as much detail as possible, being sure not to use students' names (initials are okay) in the space below:
*

Please indicate how often you've experienced incidents like this during the current school year.
*

Daily

Often

Occasionally

Rarely

Never

How satisfied were you with the way your incident was handled by administration? *

Completely unsatisfied

The incident was handled perfectly

What action was taken by administration? *

Thank you for taking the time to submit this. It will help us work with administration to find solutions to the varied behavioral problems and safety issues we face here at Gateway.

~The Gateway Executive Committee

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