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.
Sign in to Google
to save your progress.
Email Address (optional)
What is your grade?
What school do you attend?
Mark Twain Elementary School
McGrath Elementary School
Brentwood Middle School
Brentwood High School
What is your gender?
Prefer Not to Answer
If this incident occurred on the bus, which bus?
If this incident occurred in a hallway, near what classroom?
If this incident occurred in a classroom, which classroom?
When did this incident occur? (Date, time, class period)
Who was involved in the incident? (Please list all names)
Were there any witnesses? (Please list names)
Describe the incident with as much specific detail as possible.
Was there a prior incident that may have caused this incident to happen? (If so, please describe)
Did you have a role in this incident? (check all that apply)
Participant (I was part of the incident)
Observer (I saw the incident)
Walked away from the incident
Found an adult
Target / Victim (I was being disrespected)
Encourager (I encouraged the incident)
I would like to speak to a principal or counselor.
What is your name? (If you selected "Yes" to the question above)
If you would like to provide any other information not included on this form, please enter here:
Never submit passwords through Google Forms.
This form was created inside of Brentwood School District.
Terms of Service