WVPP Reporting Form

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WVPP Reporting Form

If this is an emergency, dial 9-1-1 immediately

This form is to be used to communicate concerns about workplace violence prevention. If you believe there is an imminent threat, please contact your supervisor and/or the program coordinator (John Piscitella, Asst. Supt. for HR and Community Services) directly by calling 845-620-3928 or emailing piscitellaj@pearlriver.org.

Again, if this an emergency, dial 9-1-1

IMPORTANT NOTE: The default setting for this form is anonymous so there is an option to fill in contact information within the survey.

My role in the PRSD organization is (check all that apply) *

Employee

Student

Parent

Community Member

Law Enforcement or other public safety employee

Other:

Required

Where did the incident occur? *

PRHS

PRMS

Lincoln Ave. ES

Franklin Ave. ES

Evans Park ES

District Office

Maintenance Facility (Nauraushaun)

Other:

Required

The area of my concern is *

an interaction with a person

a facility on PRSD property

a protocol of the PRSD

Other:

Required

Describe the nature of the concern. Keep in mind that there will be outreach to gather more information and/or details. Please provide names, dates, locations if possible. *

Were there any physical injuries as a result of the incident? *

Yes

Unknown

Were there any witnesses to the event? If so, please list names. *

Your name (optional)

Your phone number (optional). Include area code.

Your email address (optional).

Submit

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