School Safety Report Form
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.
* Required
Your Name (Optional)
Name of the person reporting the concern about school safety.
Name:
Your answer
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?
*
Your answer
Offender
Please list the name(s) of the person responsible for the incident.
Who is the offender?
*
Your answer
When did this incident occur?
*
MM
/
DD
/
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.
*
Your answer
Witness
Did you witness the event that concerned you?
Did you witness the event?
*
Yes
No
Other Witnesses
Please list other students or staff who may have witnessed the incident.
Who else may have witnessed the event?
*
Your answer
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?
*
Your answer
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