Brentwood School District Safe Reporting Form
Please use this form to report any incidents regarding the safety of yourself or others. Incidents may include, but are not limited to, bullying, hitting, teasing, stealing, harassment, threats of violence, or suspected drug activity.

Anonymous reports may be difficult to investigate. We encourage you to provide your name so we can follow up with you. All information is treated as confidential and the person making the report is kept anonymous towards other students.

Providing your email address is helpful, but not required.
Email Address (optional)
Your answer
What is your grade?
What school do you attend?
What is your gender?
If this incident occurred on the bus, which bus?
Your answer
If this incident occurred in a hallway, near what classroom?
Your answer
If this incident occurred in a classroom, which classroom?
Your answer
When did this incident occur? (Date, time, class period)
Your answer
Who was involved in the incident? (Please list all names)
Your answer
Were there any witnesses? (Please list names)
Your answer
Describe the incident with as much specific detail as possible.
Your answer
Was there a prior incident that may have caused this incident to happen? (If so, please describe)
Your answer
Did you have a role in this incident? (check all that apply)
I would like to speak to a principal or counselor.
What is your name? (If you selected "Yes" to the question above)
Your answer
If you would like to provide any other information not included on this form, please enter here:
Your answer
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This form was created inside of Brentwood School District.