POUSD Technology Incident Report
Please fill this form out, if your device is damaged or is no longer working. When you have completed the form, please bring your device to the library at break or your scheduled library time.
Form being completed by:
What is the Piner-Olivet Union School District number (asset tag) of the Device:
What student/s is/are assigned to this device:
People Involved: Include all names, any witnesses, and any adults present during the incident:
Were the student's parents contacted?
Please describe the incident, the steps taken afterward, and the location of where this occurred:
What was damaged :
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