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.
Your contact information:
Date of Incident
Time of Incident
People involved, including observers:
Select one of the behaviors:
Observed the behavior
Experienced the behavior
Heard about the behavior
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.
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This form was created inside of Fortuna Union High School District.