Brentwood Student Safety Report Form
At Brentwood Middle School, we pride ourselves in our welcoming school environment. As a staff, we are responsible for ensuring the emotional and physical safety for each of our students every day. Please use this form to report any activity that either makes you as a student or another student feel unsafe so our administrative team can address it. As a student, you know what is happening in our building, and we appreciate you taking the time to make Brentwood the safest place to be!
* Required
Event Description
*
Describe the event in detail including what happened, who was involved, where it happened, when it happened, and how you know about it.
Your answer
Event Type
*
Choose
Alcohol
Anger
Bullying
Cheating
Cutting/Self-Harm
Cyberbullying
Depression
Discrimination
Drugs
Eating Disorder
Family Issues
Fighting
Gang Activity
Harrassment
Sexting
Smoking
Suicide Threat
Teasing
Theft
Vandalism
Other
What time and date did the event occur?
*
MM
/
DD
/
YYYY
Time
:
AM
PM
Where did the event take place?
*
Choose
At Brentwood Middle School
At another school
At a home (your own or another student's)
At the park
At a school event
Online
Other
If the victim or suspect used social media, please select they type of social media below.
Choose
Facebook
Twitter
Instagram
Snapchat
Texting
Email
Other
Who were the individuals involved in the incident?
Name
*
Your answer
Grade
Your answer
Name of school student attends IF other than Brentwood
Your answer
Name
Your answer
Grade
Your answer
Name of school student attends IF other than Brentwood
Your answer
Additional individuals involved
Your answer
Reporter's Information
You are able to remain anonymous, but providing your information may help us to better address the situation.
Your name (optional)
Your answer
Connection to BMS
Choose
Student at BMS
Parent
Friend of a student at BMS
Concerned community member
Teacher or other school staff
Other
May we contact you?
Yes
No
Clear selection
Please provide your contact information if you are not a student.
Phone number and/or email address
Your answer
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