ER9 Incident Report Form
As members of the Easton, Redding, and Joel Barlow communities we make it a priority to care for ourselves, our community, and our world.  If you have any information that can be used to keep a classmate, friend, or community member safe from a threat, please fill out this form.  Complete the prompts that apply to the situation.  Leave the others blank.
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Name (optional) All anonymous complaints will be investigated.  However, please note that no disciplinary action shall be taken solely on the basis of an anonymous complaint.
Email address (optional):
Role of the person making the report (student, parent, teacher, etc.):
The name of the student who is experiencing or is the target of mean or harmful behavior(s): *
The name of the student being reported as committing the mean or harmful act: *
Date, time, and place of the mean/unsafe behavior(s): *
Description of the incident: *
Name(s) of witness(es):
Any additional information that you think will help us understand the incident:
Select the School Climate Specialist who will be responding to this incident: *
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