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Vista Heights Middle School Incident/Witness Report
Please be as detailed and descriptive as possible when reporting an incident, this helps our Admin conduct a proper interview and investigation of the situation.
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* Indicates required question
Email
*
Your email
Today's Date
*
MM
/
DD
/
YYYY
Last Name & First Name
*
Your answer
Student ID #
*
Your answer
Grade
*
6th Grade
7th Grade
8th Grade
N/A
Required
Person(s) Involved & Witnesses- Provide First and last name, Grade and (class shared if known) Please separate student by comma(s) ( , )
*
Your answer
Description of incident/ What happened?
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Your answer
Date of Incident
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MM
/
DD
/
YYYY
I am the
*
Choose
Witness
Victim
Offender
Time/ period incident took place
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Your answer
Location of incident
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Choose
Classroom
locker room
PE Field
Lunch Area
Lunch Tables
Black Top
6th grade area
7th grade area
8th Grade area
Girls Bathroom
Boys Bathroom
Front of School
Off Campus
Other
Who is filling out the form?
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Choose
Student
Parent/ Guardian
Staff
Other
Email Address
*
Your answer
Best Contact # for parent
Your answer
A copy of your responses will be emailed to the address you provided.
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