Incident Report

Date and Time of Incident*

:

Incident ID*

Date of Incident (YYMMDD) and last 4 of Student ID

Type of Incident*

Other Incident Type...

Sexual Battery, Assault, Harassment Type*

Please select the option you feel best fits the offense.

Theft Detail*

Please select the option you feel best fits the offense.

Weapons Incident Type*

Please select the option you feel best fits the offense.

Weapon Category*

Please select the option you feel best fits the offense.

Suffering From Injury or Illness Detail*

Please select the option you feel best fits the offense.

Physical or Verbal Altercation*

Please select the option you feel best fits the offense.

Drugs Incident Type*

Please select the option you feel best fits the offense.

Charter*

Center*

Your name*

First Name

Last Name

Position*

Your Email Address*

Principal*

Parties Involved...

Parties Involved 1

First Name

Last Name

Student's iSISTrac ID #

Position

Parties Involved 2

First Name

Last Name

Student's iSISTrac ID #

Position

Parties Involved 3

First Name

Last Name

Student's iSISTrac ID #

Position

Any of the students involved in Special Education?

Yes No

Name of Special Education Student

First Name

Last Name

Student's iSISTrac ID #*

Detailed explanation of incident:*

Please provide details based on observations you have made and know to be factual

Were the student(s) given an opportunity to write a Student Statement?

Yes No

Please attach Student Statement(s) No File Chosen

File uploads may not work on some mobile devices.

If no, briefly explain why.

Were the parents contacted?

Yes No

Spoke with parents?

Yes No

Parent Phone Number(s)

Notes from conversation with parents:*

Were the Police contacted?

Yes No

Police Report Case Number

Recommendation for Suspension

Do you wish to recommend suspension?

Yes No N/A

If yes, please include the offense of the student that makes him/her eligible for suspension (use direct quote from the Student Handbook).

Action Taken By (choose one):*

Supervisor Assistant Principal Principal Administrator Director of Instruction Superintendent

What further support or assistance do you need, if any?

Follow up Phone Number*

Please provide a phone number for any follow up regarding this incident.

Signature of Reporting Staff*

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Use your mouse or finger to draw your signature above

Signature of Supervisor

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Use your mouse or finger to draw your signature above

Student Related Incident Report

Parties Involved...

Recommendation for Suspension