If this incident is urgent, please call school immediately at 381-3370 in addition to filling out the report. 

This report form will be directed to one e-mail mailbox. Estimated time of response can vary. This report will first be forwarded to team for intervention, then to counselor, then to administration if previous interventions were not successful.

Child's Name (Victim)

Grade        Team 

Where did the incident occur?

When did the incident occur? 

Describe the incident including the names of any other children involved. Be sure to indicate what role each child had in the incident. This will help us in getting correct information.