INCIDENT REPORT
THIS FORM HAS TWO PURPOSES:

1. To fill out an INCIDENT REPORT about an incident on campus. You can use this form to tell Admin about a potential conflict, lost or stolen items, something you saw, vandalism, your side of a story etc.

2. For students receiving an OFFICE REFERRAL to provide an incident report as part of the investigation and processing of behavior office referrals.

*This form is completely confidential. Only staff members will be able to see who is submitting them.
* THIS FORM IS ONLY MONITORED DURING SCHOOL HOURS.
* THIS FORM IS NOT FOR EMERGENCIES. Please immediately report emergencies to Lakeside staff.

Email address *
Date? *
MM
/
DD
/
YYYY
Last Name, First Name *
Your answer
ID# *
Your answer
GRADE *
Who is your counselor? *
Pick a category to describe the incident. *
Names of all people involved. *
Your answer
Where did the event occur? *
Your answer
When did the event occur? What Period? *
Your answer
WHAT HAPPENED? (Give as much detail as possible.) *
Your answer
By typing my name below, I declare the statements I have written are true. *
Your answer
Submit
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