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Incident Report Form
This form is intended to alert school personnel of concerning incidents that have involved students in the Walpole public schools. Once submitted, the reporter should hear from a representative from the school within 48-72 business hours.
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* Indicates required question
Reporter's Name
While we do not require a name, it is helpful for us to be able to contact you for additional information if needed as part of the investigation of the incident. This information is kept confidential.
Your answer
Reporter's Email Address
While we do not require an email, it is helpful for us to be able to contact you for additional information if needed as part of the investigation of the incident. This information is kept confidential.
Your answer
Date of Incident
*
If you do not have the precise date of the incident, please list the date as the 1st day of the month that incident took place.
MM
/
DD
/
YYYY
Names of Individuals Involved
*
Please list the full names of any individuals who were present during the incident. Multiple names can be listed on separate lines.
Your answer
Did this incident happen during the school day on school property?
*
School day includes after school activities, school sponsored events and athletic activities.
Yes
No
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