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Incident Report Form
Form due within 48 hours of incident.
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* Indicates required question
Date:
*
MM
/
DD
/
YYYY
School:
*
Choose
Armona Union Academy
Bakersfield Adventist Academy
Central Valley Christian Academy
Dinuba Junior Academy
Foothill Adventist Elementary School
Fresno Adventist Academy
Miramonte Christian School
Monterey Bay Academy
Mother Lode Adventist Junior Academy
Mountain View Academy
Sierra View Junior Academy
Valley View Adventist School
VHM Christian School
Athletic Director (First & Last Name)
*
Your answer
Principal (First & Last Name)
*
Your answer
Position
*
Your answer
Date of Incident:
*
MM
/
DD
/
YYYY
Event:
*
Your answer
Event Location:
*
Your answer
Describe Incident:
*
Your answer
What action was taken at the scene?
*
Your answer
What further action needs to be taken to prevent a reoccurrence of this incident?
*
Your answer
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