Incident Report

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Incident Report

Students and parents can anonymously submit any suspicious activity, bullying or other issues by using this form. We encourage all of our students and families that if you see something, say something. You have the option of including your contact information or reporting anonymously. Once submitted, an administrator will be notified and begin an inquiry of your issue. Initial contact should be expected within 24 hours or the next school day.

False reporting will be taken seriously to the full extent of the law.

Contact information of reporter email/phone *

Name of Reporter (Optional)

Date of Incident *

YYYY

Time of Incident *

Time

Student(s) Involved in incident (Person(s) Initiating incident: *

Student(s) Affected by incident *

Type of Incident *

Bullying (The behavior is repeated, or has the potential to be repeated, over time.)

Harassment ( any unwanted behavior, physical or verbal (or even suggested), that makes a reasonable person feel uncomfortable, humiliated, or mentally distressed.)

Threatening verbal/physical

Health or safety concerns

Cheating

Other:

Required

Describe the incident *

Witness Present

Physical Evidence

Graffiti

Notes

E-mail

Video/Audio

Text Messages

Social Media

Other

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