West Monona CSD Incident Reporting Form
It is the policy of the West Monona Community School District not to illegally discriminate on the basis of race, color, national origin, sex, disability, religion, creed, age (for employment), marital status (for programs), sexual orientation, gender identity and socioeconomic status (for programs) in its educational programs and its employment practices. There is a grievance procedure for processing complaints of discrimination. If you have questions or a grievance related to this policy please contact the district’s Equity Coordinator, Tasha Lewis, 611 4th Street Onawa, Iowa 51040, 712-433-1393, tasha.lewis@westmonona.org.

Harassment and bullying of students and employees are against federal, state and local policy, and are not tolerated by the board. The board is committed to providing all students with a safe and civil school environment in which all members of the school community are treated with dignity and respect. To that end, the board has in place policies, procedures, and practices that are designed to reduce and eliminate bullying and harassment as well as processes and procedures to deal with incidents of bullying and harassment. Bullying and harassment of students by other students, by school employees, and by volunteers who have direct contact with students will not be tolerated in the school or school district.

The board prohibits harassment, bullying, hazing, or any other victimization, of students, based on any of the following actual or perceived traits or characteristics, including but not limited to, age, color, creed, national origin, race, religion, marital status, sex, sexual orientation, gender identity, physical attributes, physical or mental ability or disability, ancestry, political party preference, political belief, socioeconomic status, or familial status. Harassment against employees based upon the employee’s race, color, creed, sex, sexual orientation, gender identity, national origin, religion, age or disability is also prohibited.

This policy is in effect while students or employees are on property within the jurisdiction of the board; while on school-owned or school-operated vehicles; while attending or engaged in school-sponsored activities; and while away from school grounds if the misconduct directly affects the good order, efficient management and welfare of the school or school district.

Students who think they are being bullied or harassed will complete a bullying intake form with the investigator. If it is determined that reasonable suspicion exits for an investigation one with be carried out using the Easton Bullying Investigation System (EBIS). This includes taking statements, talking to witnesses, and determining if there is a preponderance of evidence indicating guilt.

If, after an investigation, a student is found to be in violation of this policy, the student shall be disciplined by appropriate measures which may include suspension, Saturday school, loss of privileges, or expulsion.

If after an investigation a school employee is found to be in violation of this policy, the employee shall be disciplined by appropriate measures which may include, termination. If after an investigation a school volunteer is found to be in violation of this policy, the volunteer shall be subject to appropriate measures which may include, exclusion from school grounds. “Volunteer” means an individual who has regular, significant contact with students.

Please answer these questions as honestly and specifically as you can. The situation will be handled as confidentially as possible.

When did it happen (incident date)? *
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Today's Date: *
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Building *
Person Reporting (optional)
Your answer
What type of incident do you wish to report? *
Please read the definition of each term, and pick the one that best describes the incident you are reporting.
Who is the student that is being treated improperly? *
First and last name of the student (name more than one student if necessary) being targeted by inappropriate behavior.
Your answer
How long has this negative behavior been going on? *
How long has the student been treated improperly?
Where did the incident happen? *
Select all that apply
Required
Who is the person directing the negative behavior toward you in this particular incident? *
First and last name of the person or people treating you improperly.
Your answer
What happened? *
Include as much detail as possible of the incident, dates, times, names of witnesses, names of bystanders, names of other targets, what happened, etc.
Your answer
What is the method for the delivery of improper behavior for this incident? *
Check all that apply
Required
What have you done about the problem? *
What have you said to the person responsible for the negative behavior that you've reported in this incident?
Your answer
Have you talked to anyone else about this already? *
List witnesses that saw it occur or those you have spoken to about this.
Your answer
If this is a bullying or harassment incident please describe the nature of the bullying/harassment (discrimination). Check all that apply. *
NOTE: If this is not a bullying or harassment incident please type N/A in the "other" box in the last answer slot.
Required
What do you want to happen next concerning the incident you have reported? *
Required
By clicking submit you agree that all of the information on this form is accurate and true to the best of your knowledge
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