ExCEL Crisis Form 2018-2019
*NOTE: this form is not able to be edited after you submit. Therefore, please make sure you:

1. Have all information relevant to situation (staff referring, date/time, resolution, date when administrator is notified, solution focused plan or resolution)
2. Email a copy (will be emailed to you) to your administrator and keep for your records
3. Email any additional documentation/reports to excelasp@sfusd.edu


Email Address is for SITE COORDINATOR's email address.

Email address *
Staff Completing Form
Your answer
Site Coordinator Name *
Your answer
Site Coordinator Email Address
Your answer
School Site *
Victim(s) Names (First and Last Name)
Your answer
Victim(s) are
Assailant(s) Names (First and Last Name)
Your answer
Assailant(s) are
Witness(s) Names
Your answer
Date of Incident *
MM
/
DD
/
YYYY
Time of Incident *
Time
:
Location of Incident *
Check at lease ONE of the following *
Required
Describe the Incident (Who, What, Where and When): *
Your answer
Describe Action Taken (Who, What, Where and When): *
Your answer
Investigation is *
Administrator Notified (Name/Title) *
Your answer
Parent(s) notified? *
Parent Name and Contact Information
Your answer
Prior to Calling SFPD? *
Name/Title of Person Making Contact with Parent:
Your answer
If the caretaker was NOT contact, explain
Your answer
Police Called *
If Police was called, by whom?
Your answer
If Police called, SFPD Officer's Name and Star #
Your answer
If Police called, SFPD Report #
Your answer
If Police interviewed student(s), names of person(s) present during interview
Your answer
ExCEL Referral Form *
ExCEL Injury Form *
Were any students suspended? *
If suspension or expulsion was used, please describe:
Your answer
Who will be conducting follow up regarding supports and contacting appropriate parties? *
Required
Next Steps: by checking below, I acknowledge that I *
Required
A copy of your responses will be emailed to the address you provided.
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