School Incident Report Form
School Incident Report Form
Please fill out this form to report an incident that occurred.
Incident Information
Incident Date and Time
Location of Incident
Type of Incident
Individuals Involved
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No. |
Name |
Role |
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2 |
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3 |
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4 |
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5 |
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6 |
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8 |
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9 |
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10 |
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Incident Description
Describe the events in as much detail as possible.
Was school staff notified immediately?
Were the parents or guardians notified?
Communication Method
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Email
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Phone
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In Person
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Reporter Information
Report Date and Time
Name
Role
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Student
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Teacher
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Staff Member
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Parent
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Phone number
Certification
I certify that the information provided in this report is true and accurate to the best of my knowledge.
Name:
Date:
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