See Something, Say Something!
This form is to be used to report any school-related safety concerns (threats, theft, fights, vaping, illicit drugs, intoxicating substances, vandalism, etc.). If you have any information that could help to keep you and others safe, please share it here.  Your administrators will do their best to help resolve the situation and maintain your confidentiality. Thank you for helping to make ʻIlima Intermediate a safe place for everyone.
Sign in to Google to save your progress. Learn more
Email *
Name (First & Last) *
Grade *
Date of incident *
MM
/
DD
/
YYYY
Time of incident *
Time
:
Location of incident *
Who was/is involved (if known) *
Tell us more about the incident. Provide any additional details. *
Do you have more information such as screenshots, text messages, etc... that you need to share? If yes, please fill in a phone number that we can reach you at.
Acknowledgement *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Hawaii Department of Education.

Does this form look suspicious? Report

Google Forms