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Chambers Incident Report
This form may be used by any student or adult to report "mistreatment by others." This may include alleged bullying, harassment, discrimination, injury or cyber related incidents.
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* Indicates required question
Reporting Person
*
Your answer
Contact Information (home phone/cell/email
Your answer
Incident Date
*
Your answer
Name of adult(s) you've already contacted if any.
Your answer
Name(s) of accused
*
Your answer
Where did the incident happen
*
Classroom
Hallway
Restroom
Gym
Locker Room
Lunchroom
Sport Field
School Bus
Internet
Cell Phone
Outside
Another Campus
To/From School
Other:
Required
Describe what happened. Use all exact language and as much detail as possible. If I were watching it on video, what exactly would I see.
*
Your answer
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