Safety Reporting

Fill in the form below. Required fields are marked with .

IF THIS IS AN EMERGENCY CALL 911

What type of Safety Concern are you Reporting?

I want to report a:

Check all that apply:

Student/s was placed in reasonable fear of harm to their person (i.e., body) or their property.
Student/s experienced a substantially detrimental (i.e., significant) effect to physical or mental health.
Student/s experienced substantial interference in their academic performance.
Student/s experienced substantial interference in their ability to participate in/benefit from school services, activities, or privileges.

When did the incident take place?

Date of Incident:

Approximate Time of Incident:

Where did the incident take place?

School/Site:

Location:

The incident occurred during:

Who was involved?

Who is the victim?

Who is the suspect?

Did anyone witness the incident? If so, who?
Did you witness the incident or did you hear about it later?

What happened?

Describe the incident: Please include all important details.

Do you have a related image? If so, you can attach it to your report to help provide additional information.

Contact Information (Optional)

You have the option to leave your personal contact information. If provided, you may be contacted for more information if necessary.

First:

Last:

Email:

Phone:

U-46 - Report Bullying or Threats