LFO Band Booster Incident Report Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form is used to submit and document incidents brought to the attention of the LFO Band Booster Organization.

Today's Date *

YYYY

Name of person recording incident *

Names of People Involved - include the following in the list of people: injured/not inured, LFO/LMS/Other, Student/Parent-Guardian/Faculty/Other, Participant/Witness/Heard from another source. (Example: Jane Doe - not injured, LFO, Parent, witness) *

Did the incident occur during a school function *

Immediately before the functin

During the function

Immediately after the function

En route to or from the function while riding on transportation provided by the school

Name of School Function, if applicable

Incident Date *

YYYY

What time did the incident begin? *

Time

Incident Location

Cyber Bullying

On LMS school grounds

On LFO school grounds

On another school grounds

En route to or from the school function while riding on transportation provided by the school

At field trip, concert, competition, food/pit stop, or exhibition location

Electronic communication including, but not limited to text, instant messaging, and social networking

Other:

Clear selection

Incident Description (NOTE: If additional information is requested, the report will remain open for 30 days. If requested information is not provided within 30 days, the incident report will be closed) *

LFO Band Booster Board Action (to be completed by LFO BB Board)

No Action

Booster organization takes action without notifying others

Notify Parent/Guardian

Notify LMS Band Director

Notify LFO Band Director

Notify Colorguard Faculty Member

Notify LMS Counselor

Notify LFO Counselor

Notify LMS Assistant Principal

Notify LFO Assistant Principal

Notify LMS Principal

Notify LFO Principal

Action Pending

Other:

Clear selection

LFO Booster Board Statement (to be completed by LFO BB Board)

Date LFO Band Booster Board takes action or updates this incident. (to be completed by LFO BB Board)

YYYY

Is the Incident open or closed? (to be completed by LFO BB Board)

Incident is open.

Incident is closed.

Clear selection

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms