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.
Date *
MM
/
DD
/
YYYY
Form being completed by: *
Your answer
What is the Piner-Olivet Union School District number (asset tag) of the Device: *
Your answer
What student/s is/are assigned to this device: *
Your answer
People Involved: Include all names, any witnesses, and any adults present during the incident:
Your answer
Were the student's parents contacted?
Please describe the incident, the steps taken afterward, and the location of where this occurred: *
Your answer
What was damaged : *
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