Incident Reporting Form -                       Central Middle School
GLOSSARY:
incident - what happened
perpetrator - someone who causes suffering to another
anonymous - no one knows your name
victim - someone who has suffered as a result of the actions or negative attitudes of someone else
reporter - person who is filling out this form
witness - others who saw what happened
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Date of incident *
MM
/
DD
/
YYYY
Time of Incident *
Time
:
Location of Incident
Be as specific as possible.  
Example:  instead of "hallway", write "hallway, near the drinking fountain, in the 6th grade hallway"
 *
Has this happened before?

 *
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