School Safety Report Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

MCUSD 709 is committed to creating a safe and supportive learning environment for all students. School incidents involving school safety, including bullying, are taken very seriously. When a concern about school safety is reported, support services can be provided to all students involved. The includes the offender, the victim, and any bystanders.

This form has been created to help provide a safe means of reporting a concern about school safety. It is designed to remain anonymous and it is encouraged that bystanders who hear or see a threat against school safety (this includes bullying and/or concerns about self-harm) report their observations so appropriate action can be taken. Anyone, including victims, may use this form to report concerns.

Thank you for taking the time to complete the "School Safety Report Form." MCUSD 709 appreciates your help in maintaining a safe environment for our students.

Your Name (Optional)

Name of the person reporting the concern about school safety.

Name:

Location of the safety concern. *

Lincoln Elementary School

Grundy Elementary School

Lettie Brown Elementary School

Jefferson Elementary School

Morton Junior High School

Morton High School

Person Reporting

Please check the appropriate box.

I am a... *

Student

Parent/Guardian

Community Member

Staff Member

Victim

Please list the name of the person being bullied or mistreated

Who is the victim? *

Offender

Please list the name(s) of the person responsible for the incident.

Who is the offender? *

When did this incident occur? *

YYYY

Incident Type

Please choose from the list of options below

What type of incident occurred? *

Physical--hurting a person's body or possessions

Verbal--saying or writing mean or threatening things

Social--hurting someone's reputation or relationships

Cyber--willful or repeated harm through the use of a computer, cell phone, social media, etc

Required

Description of events

Please provide a detailed description of the events. Tell the whole story including location, date, and time of the event. Give as much detail as possible.

Give a detailed description of what happened. *

Witness

Did you witness the event that concerned you?

Did you witness the event? *

Yes

Other Witnesses

Please list other students or staff who may have witnessed the incident.

Who else may have witnessed the event? *

Length of time

Please report whether this is the first time that something like this has happened or if it has been going on for a longer period of time (days, weeks, etc)

How long has this been happening? *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Morton Unit District 709. Report Abuse

Forms