Incident Report Form 2023-24

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Please use this form to report incidents that took place in school or online (social media.) Forms will be reviewed throughout the day and prioritized based on your responses.

If this is an emergency and/or a potential threat to school safety, please notify a teacher, counselor or administrator immediately.

Email *

Record my email address with my response

First Name *

Last Name *

Priority level *

This is urgent and needs to be addressed immediately.

It is important, but can wait a couple mods.

It can wait till tomorrow if needed.

I just want this reported, no rush.

Who is completing this form? *

Student (Involved student - I am part of the situation)

Student (Witness - I saw it happen)

Teacher on behalf of the student

Other:

What happened? Please describe the incident including anyone else who was involved. *

Where did this happen? (Be as specific as possible. For example, "In the hall near room 204.) *

When did this happen? (Be as specific as possible. For Example, "11:23" or "Between mods 5 & 6" *

What was your role in this situation? *

What are you willing to do to improve this situation? *

Have you reported this previously? *

Yes

Is this an ongoing issue? *

This is a single occurrence or the first time

This is an ongoing issue

How would you like this handled? *

Nothing, I just want it on record in case something happens in the future.

I would like my counselor to call me down. (I need help solving the problem. For example, peer remediation.)

I want an administrator to call me down. (This is ongoing and other methods have not worked.)

Send me a copy of my responses.

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