Emergency Check-In

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Emergency Check-In

Use this form to mark if you are SAFE during a lockdown/off campus evacuation.

If you are NOT in a safe place, call 911 immediately.

Email *

Identify Yourself *

I am an Ilima student.

I am a parent/guardian of an Ilima student.

I am Ilima staff member.

Students Only: Check all that apply

I am safe

I am off campus

I am with a parent/guardian

I am with a trusted adult

Parent/Guardians Only: Check all that apply

My child is safe with me.

My child is safe with a trusted adult.

My child is off campus.

Staff Only: Check all that apply

I am safe

I am off campus

I am on campus, not in my room

List the FIRST and LAST name of all students that are being checked in as SAFE. (If you are student, this includes you.)

If you are a PARENT/GUARDIAN, please enter your FIRST and LAST name.

If you are a STAFF member, please enter your FIRST and LAST name.

Please enter a phone number, address, and/or current location in the event we need to contact you. *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Hawaii Department of Education.

Does this form look suspicious? Report