School Incident Report Form
Please complete one form for each “incident of prohibited behavior” which occurs on school property
during school hours or during school sponsored activities.
Date of Incident_________ Person completing form______________________ School__________________
OFFENDER(S)______________________________ Age____ Grade____ M or F____ Special Ed.____
______________________________ Age____ Grade____ M or F____ Special Ed.____
VICTIM(S)____________________________________ Age_______ Grade_______ M or F______
____________________________________ Age_______ Grade_______ M or F______
VIOLENCE INCIDENT: Fighting_____ Pushing_____ Stealing_____ Swearing_____
Threat/Intimidation____ Hate Crime____ Harassment____ Sexual Offenses____ Racial/Sexual Bias_____
Describe what happened____________________________________________________________________
VANDALISM INCIDENT: Describe what happened_______________________________________
__________________________________________________________________________________________
SUBSTANCE ABUSE: Describe (Alcohol, Marijuana, Tobacco, etc.)___________________________
__________________________________________________________________________________________
WEAPONS: Describe incident_____________________________________________________________
__________________________________________________________________________________________
ACTION TAKEN:
1. Detention or loss or privilege____
2. In school suspension____
3. Out of school suspension____
4. Alternative placement_____
5. Expulsion from school_____
6. Law enforcement referral_____
| Attachment | Size |
|---|---|
| School_Incident_Form.pdf | 15.08 KB |