AR-Safety Complaint
Safety complaints are to be filed in situations where someone witnessed or experienced behavior that caused physical or emotional harm. The behavior could be physical, verbal, or nonverbal.
Email address *
Your name: *
Your contact information: *
Date of Incident *
MM
/
DD
/
YYYY
Time of Incident *
Time
:
People involved, including observers:
Select one of the behaviors:
Detailed description of the incident:
All Safety complaints could result in the following:
1. Conversation with the program director.
2. Issued a broken agreement with additional consequences such as: peer mediation, peer listening, letter home, parent meeting, suspension from school, expulsion.
Submit
Never submit passwords through Google Forms.
This form was created inside of Fortuna Union High School District. Report Abuse