PVMS Incident Reporting System
This form may be submitted anonymously.
Please answer all that apply and provide as much detail as possible.
The more information we have, the more we can help!
This form is not intended to be used as a method to file a formal complaint against PVMS Teachers or staff member. If you have a concern or complaint about a PVMS Teacher or a member of our staff please contact the school administration directly so the matter may be addressed in the appropriate manner.
I am a
During this incident I was a
What is your name? (Optional)
May we contact you?
What grade are you in?
What is the name of the student you would like to report?
Where did this incident take place?
Type of incident being reported?
Cyberbullying - please email screen shots to
Weapons on Campus
Drugs on Campus
Please describe the incident.
Where there witnesses to this incident?
If so, what are the names of the witnesses?
Please rate the severity of this incident from your perspective
Minor incident but unacceptable
Major incident, may result in retaliation, violence or harm.
Please describe the frequency with which this type of incident occurs.
All day every day
How do you feel about this incident or person? Examples: annoying, I hate them, I want to hurt them, they don't make me mad I just want it to stop, etc.
Did this or other incidents make you feel like harming yourself or others?
Would you like to speak with a counselor about this incident?
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