Free Public School Incident Report Template
Public School Incident Report
I. Incident Details
Student Information
|
Field |
Information |
|---|---|
|
Name |
Allan Holt |
|
Grade |
5th Grade |
|
Age |
11 |
|
Gender |
Male |
|
Student ID |
12345 |
Incident Information
-
Date of Incident: May 1, 2054
-
Time of Incident: 10:30 AM
-
Location: Classroom 203
-
Description of Incident: Allan got into a physical altercation with another student during recess.
II. Witnesses
|
Witness Name |
Role |
Contact Information |
|---|---|---|
|
Mrs. Johnson |
Teacher |
johnson@email.com |
|
Sarah Thompson |
Student |
sarah@email.com |
Witness Statement
Mrs. Johnson: "I saw Allan and the other student pushing each other and then it escalated into a fight. I intervened immediately."
III. Behavior Details
-
Behavior Description: Physical altercation
-
Target of Behavior: Another student
-
Context of Behavior: During recess
Behavior History
-
Previous Incidents: Allan has had two previous incidents of disruptive behavior in class.
-
Behavioral Patterns: Allan often displays impulsive behavior when provoked.
IV. Actions Taken
-
Immediate Response: Separated the students and calmed them down.
-
Follow-Up Actions: Disciplinary action was taken, and Allan was sent to the principal's office. He was also assigned detention for the rest of the week.
V. Recommendations
-
Preventive Measures: Implementing conflict resolution programs to help students manage conflicts peacefully.
-
Parent/Guardian Notification: A notification was sent to Allan's parents, and a meeting is scheduled for tomorrow.
VI. Additional Information
-
Attachments: None
School: [YOUR COMPANY NAME]
Address: [YOUR COMPANY ADDRESS]
Website: [YOUR COMPANY WEBSITE]
Social Media: [YOUR COMPANY SOCIAL MEDIA]
