Lopatcong Township School District  School and Student Safety/Threat Assessment Report Form
Directions: This form should be used to report concerning behaviors or threats made against any individual or threats made against the school/district. Concerning behavior can include: behavior that is threatening or engaging in violence, bringing a weapon to school, bullying or harassing others, and other concerning criminal behaviors. While some actions, words or behaviors may not pose an immediate threat to others, or be considered criminal, it is important to identify behaviors that indicate a sudden change in personality or demeanor. These behaviors can include becoming withdrawn or isolated, unusual interest in violent topics, increased anger or irritability, known substance use, or bizarre communications that can be interpreted as a threat. All concerns should be reported to the building principals or other administration. Never assume someone else will make the report. All reports will remain confidential to the greatest extent possible. 

Please answer each question as accurate as possible. 

Any false reports made with malicious or mal intent will face discipline based on the student code of conduct.  


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School of Concern *
Your name and relationship to the individual of concern? (Please do not include your name if you wish to remain anonymous) 
*
Phone number and email :
What prompted you to fill out this form? Please be specific (include who you are concerned about, actions you are concerned about, how were you made aware of the incident/concern).  *
Date of incident or date concerning behavior was observed: *
MM
/
DD
/
YYYY
Where did the incident occur? *
Was the incident/threat reported to law enforcement? *
Is the offender an adult or a student? *
Does the person of concern attend school or work at Lopatcong Township School District? *
Is there a target/victim of the threat or behavior? *
Is the victim a student at Lopatcong Township? *
Is the victim an adult? *
Victim's name (use NA if no victim): *
Witness names (use NA if no witnesses other than the person filing the report): *
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