LPS Incident Reporting Form
About. Please use this form to report concerns about a student's ability to appropriately access their education  or a staff member's ability to work due to the actions of another member of our community (e.g., bullying, harassment, etc.).  Note that an aggressor or perpetrator can be any member of our school community, including a staff member.

This form can also be used by LPS staff members who wish to make a formal report of potential bullying or civil rights violations that involves a student as a target or a colleague who they feel is the victim of workplace discrimination and/or harassment.

The information you provide will be emailed to a staff member in the Office of Equity & Student Support, as well as building administrators when a building is selected below.  All staff reports will also be sent to the Assistant Superintendent of Personnel and Staff Support. These staff members will check their email DURING REGULAR SCHOOL HOURS.

If building administrators or members are the alleged aggressor(s), please reach out to the Director of Equity & Student Support directly. If the Director of Equity & Student Support is the alleged aggressor, please reach out to the Assistant Superintendent for Personnel and Staff Support directly.

If you or someone you know is in IMMEDIATE DANGER, please call 911. Other helpful resources include: 
  • Boston area Samaritans 24-hour Suicide Prevention Hotline: 1-617-247-0220
  • National Sexual Assault Hotline: 1-800-656-4673
NOTE: You can make this report completely anonymous by not telling us your name (we won't know who you are). However, it may impede the investigation in the event that we have clarifying questions about your report.  If you choose to tell us who you are, we can maintain your anonymity in most cases.  Also, in most cases, traditional disciplinary action cannot be taken against an alleged aggressor solely on the basis of an anonymous report.
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As noted above, you may choose to make this report completely ANONYMOUS; however, anonymity severely limits the district's ability to take action in correcting any behavior that impacts another student's access to their education or a staff member's ability to work.  In most cases, we can maintain a reporter's anonymity, and you can be consulted regarding that status through the process of investigation.
Anonymity *
First Name
(optional)
Last Name
(optional)
Target or Reporter *
Check whether you are the:
Role *
Check whether you are a:
Required
Contact Information
Email and/or telephone number
Contact Preference *
Select all that apply
Required
School/District Location *
If you are affiliated with a specific school, please indicate the school:
Sharing *
I understand this report will be shared with my building administration (who will investigate the incident). 
Comments
Would you like to elaborate on any of your responses above?
Information About the Incident(s)
Please provide as much detail as possible, including dates, times, and names of others.
Name(s) of Target(s) *
Name the target(s) of the behavior
Name(s) of Aggressor(s) *
Name the person(s) who engaged in the behavior
Date(s) *
Date(s) the incident(s) occurred
Time *
Time(s) the incident(s) occurred
Incident Location *
Name the location(s) of the incident(s)
Witnesses *
List people who saw the incident(s) or have information about it.  If there are none, please indicate that.
What happened? *
Select all that apply
Required
Incident Description *
Describe the details of the incident (including names of people involved, and what each person did and said, including specific words used).
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