SHS Incident Report Form 2023-24

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Our goal is to create learning and working environments where all feel valued, respected and treated fairly.

Students, staff and families can use the forms below to report incidents, behaviors, or speech that does not support this goal. If it is not reported then we cannot respond!

You can report something that happened to you or someone else, or something you heard or observed.

All reports are taken seriously and appropriate action will be taken by administrators.

You can report anonymously, but know that if you choose to remain anonymous, no disciplinary action can be taken. There is no time limit for reporting, but the sooner you report, the sooner we can investigate and address it.

Reporting is protected, and retaliation on reporters is prohibited. If this happens to you, you should report retaliation here as well.

For more detailed information, please see Swampscott Public Schools’ Bullying Prevention Plan, Civil Rights Procedures, and/or Title IX procedures (for sexual harassment or gender discrimination).

If you would like to report anonymously, please enter a@swampscott.k12.ma.us as your email.

Email *

Are you the: *

Target of Behavior

Reporter (not the target)

Required

Your first name (leave blank if you wish to report

anonymously)

Your last name (leave blank if you wish to report anonymously)

Are you: *

Your phone number or email that we can contact you at? If you are a school employee, please type in your email and classroom extension *

What are you reporting? (Check all that apply) *

Bullying

Discrimination

Hate speech

Harassment

Racism

Other:

Required

Name of Person(s) who engaged in the above behavior: *

Name of Person(s) who was targeted by the above behavior: *

Is the alleged aggressor a Swampscott Public Schools staff member? *

Yes

Grades of Students Involved (Check all) *

Required

Date *

YYYY

Approximate Time *

Time

Location *

On School Property

On the Bus

On the way to/from school

At a school-sponsored activity or event

Internet

Other:

Required

Briefly describe what happened (what occurred, specific words of what each person said and did) *

Witnesses: list all people who observed the incident or have information about the incident and their role (e.g. John Smith - Student) *

A copy of your responses will be emailed to the address you provided.

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