North Country-CJUSD Student/Staff Accountability and EOC Form
Your careful and accurate completion of this form will allow us to accurately account for our students and staff as well as to inform us about injuries and conditions of buildings and classrooms.
Email address *
Student/Staff Accountability
Room Number *
Your answer
# of students enrolled in this class *
Your answer
# of students marked absent today *
Your answer
Please list students marked absent by first and last name. *
Your answer
# of students "unaccounted for": (If a student is on your class roster, but not under your direct supervision right now, s/he is "unaccounted for".) *
Your answer
Please list students "unaccounted for" by first and last name: *
Your answer
#of "extra" students: (If a student is under your direct supervision right now, but not on your class roster, s/he is "extra".) *
Your answer
Please list "extra" students by first and last name: *
Your answer
Are there any adult staff from this room "unaccounted for"? If so, please list by first and last name: *
Your answer
Are there any "extra" adult staff in this room? If so, please list by first and last name: *
Your answer
Student/Staff Injury Report
Please indicate how many people in each category.
Minor Injuries (Green) First Aid Only *
Your answer
Moderate: (Yellow) Burns, major multiple fractures, back injuries with or without spinal cord damage *
Your answer
Major: (Red) Unable to treat on site, i.e. airway & breathing difficulties, cardiac arrest, uncontrolled or suspected severe bleeding, severe head injuries, severe medical problems, open chest or abdominal wounds, severe shock *
Your answer
Fatalities: (Black) *
Your answer
Property Damage Report
Please select the option that best describes the current condition of your classroom/building
Property Damage: *
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