Safety Reporting Form

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

Providing a safe, secure, and respectful learning environment for all is of the utmost importance to us. This includes when students are in our schools, on school grounds, on school buses/vehicles, and at all school-related activities. This reporting tool helps to ensure the safety and security of students and provide assistance and support to those who need it.

Please the Safety Reporting Form to report the following:

- Concerning warning signs and/or threats
- Illegal and/or dangerous items
- Concerns about bullying, intimidation
- Self-harm, or suicide
- Concerns about mental health
- Any other concerns regarding the safety of our students

We encourage students, parents and community members to partner with us to keep our school safe. If you see or hear something, say something.

This form is anonymous (unless you choose to leave your name) and will be shared with appropriate administrative school members for further action.

This is a serious communication tool: there may be consequences for intentionally sharing a false information.

***NOTE*** This site is not monitored 24/7 and should not be used for reporting emergencies/matters requiring immediate attention. If you need to report an emergency or require immediate attention, call 911.

As always, please feel free to reach out to our staff directly by email or phone.

Thank you for doing your part in keeping our schools and community safe for our students!

*Required

I am a Concerned: *

Student

Parent/Guardian

Community Member

If known, name of person(s) causing harm or potentially causing harm:

Name of person(s) being harmed or in danger of being harmed

Please describe the situation/incident or concern. Please use as much detail as possible. *

Which school does this pertain to? *

Glen Hills Middle School

Parkway Elementary School

Not sure

Date(s) of incident(s) if known:

Location of incident(s) if known:(hallway, cafeteria, playground, etc.)

This situation is a: *

One time incident

Recurring situation

I am not sure if this is a one time incident or recurring situation.

Are there any witnesses or others who may have knowledge of this situation?

I will include my name: (Optional)

I will include my email in case you need to contact me:(Optional)

I will include my phone number in case you need to contact me: (Optional)

Is there anyone specific you want notified of this situation? (Optional)

I want someone to follow up with me. *

Yes

If you want someone to follow up, how should we contact you?

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Glendale River Hills School District.

Does this form look suspicious? Report

Forms