Safe School Climate Report
Person Reporting Incident (name not required) *
Choose "Anonymous" to remain completely anonymous, and choose "Other" to report your name.
Required
Alleged Victim Name *
Your answer
Alleged Perpetrator Name(s)
Your answer
Potential Witnesses Names
Your answer
Date & Time of Alleged Incident
If Known
MM
/
DD
/
YYYY
Time
:
Where did the incident happen *
Check all that apply
Required
Check the statement(s) that best describes what happened. *
Check all that apply
Required
Summarize Incident *
Your answer
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