Section | Details |
---|---|
Name: | [Your Name] |
Email: | [Your Email] |
Position: | Teacher |
School Name: | [Your Company Name] |
Section | Details |
---|---|
Incident Date | May 30, 2050 |
Incident Time | 10:00 AM |
Location | Classroom 101 |
Section | Details |
---|---|
Student Name: | [Student Name] |
Grade/Year: | 4th Grade |
On May 30, 2050, at approximately 10:00 AM, the student, [Student Name], disrupted the classroom environment by yelling and refusing to follow instructions.
This behavior occurred during a Math lesson. Despite multiple warnings and requests to settle down, the student continued their disruptive behavior, causing significant distraction to other students in the class.
Initially, I, [Your Name], attempted to calm the student with verbal warnings. When this proved ineffective, I paused the class to address the student's behavior directly, requesting that they cease yelling and follow instructions.
The student continued to refuse compliance. I then asked the student to step outside the classroom to discuss the matter further.
The student eventually complied with this request after several minutes and a call to the school administration was made to assist with further intervention.
Witness 1: [Teacher Assistant Name], Teacher Assistant
Witness Statement: "I observed [Student Name]'s disruptive behavior and can confirm the teacher's account."
Witness 2: [Student Name], Student
Witness Statement: "I saw [Student Name] yelling and not listening to the teacher."
Given the severity and recurring nature of the student's disruptive behavior, I recommend the following actions:
A meeting with the student's parents or guardians to discuss behavioral expectations and consequences.
Referral to the school's guidance counselor for ongoing support and behavior management strategies.
Consideration of specific classroom behavior management plans tailored to the student's needs.
Reporter Name: [Your Name]
Date: May 30, 2050
Templates
Templates