CIMS 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 CIMS Teachers or staff member. If you have a concern or complaint about a CIMS Teacher or a member of our staff please contact the Principal or Assistant Principal 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 was the name of the student you would like to report? *
If you do not know the name of the student, please describe the person and how you know him/her. *
Where did this incident take place? *
Type of incident being reported *
Please describe the incident? *
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. *
First time
All day or every day
Did this or other incidents make you feel like harming yourself or others? *
What else would you like us to know about this incident? *
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