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HOP Incident Report
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* Indicates required question
Email
*
Your email
Date of report:
*
MM
/
DD
/
YYYY
Date of incident:
*
MM
/
DD
/
YYYY
Time of incident:
*
Time
:
AM
PM
Location of incident: (classroom, playground, hallway, etc)
*
Your answer
Full name of person completing report:
*
Your answer
Please keep me anonymous.
*
Yes
Not necessary
Required
Role of person completing report:
*
Teacher
Administrator
Parent or guardian
Other:
Required
Student(s) involved:
*
Your answer
Other individuals involved:
*
Your answer
Description of incident: (Provide a clear, factual, step-by-step account of what happened. Avoid opinions or assumptions.)
*
Your answer
Actions taken: (What was done immediately after the incident? Include redirection, separation, first aid, parent contact, etc.)
*
Your answer
Was property damaged?
*
Choose
Yes
No
Was parent/guardian notified?
*
Yes, in person.
Yes, by phone.
Yes, by email.
No.
Other:
Required
Follow-up needed from HOP Action Committee?
*
Your answer
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