*Welcome to POLA Report*
Port of Los Angeles High School (POLAHS) Situation Reporting Form
Be sure to fill out all sections and provide necessary details when making your report regarding an ongoing situation or incident.
Requests for confidentiality will be respected EXCEPT in the case of
1) abuse, 2) there's significant danger to yourself or to others or 3) the law/court requires the sharing of information.

Formulario para reportar problemas serios a la administración.
Visite tinyurl.com/pola-report2 para acceder la versión en español

Personal Information
Do you want this report to be kept confidential and private? *
Your Full Name *
Your answer
Your Role *
Phone Number *
Your answer
This is a... *
Alternate Phone Number
Your answer
Email (if available) *
Your answer
Report Details
Please give details about the situation (What? Where? Who? When?)
Date of incident *
MM
/
DD
/
YYYY
Approximate Time of Incident *
Time
:
Describe the situation you're reporting on below. (Even though only one line shows you can be as detailed as possible-- it will add lines.) *
Your answer
How urgent is this concern for you? *
Not urgent (Info only)
VERY urgent (Need for action ASAP)
Additional Support Information
Possible eyewitnesses 1 *
Your answer
Possible eyewitnesses 2
Your answer
Possible eyewitnesses 3
Your answer
Screenshots / Video / Photos
If you have any images or video that could help us understand the situation better, please share them with pjohnson@polahs.net
Submit your information below
Submit
Never submit passwords through Google Forms.
This form was created inside of Port of Los Angeles High School. Report Abuse - Terms of Service