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Document ID INCIDENT1 |
Title Incident Report |
Print Date 05/17/23 |
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Revision 1.1 |
Prepared By EC Leadership Circle |
Date Prepared 05/17/23 |
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Effective Date 05/17/23 |
Reviewed By EC Leadership Circle |
Date Reviewed 05/17/23 |
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Approved By EC Leadership Circle |
Date Approved 05/17/23 |
Process:
- Once the situation is non-emergent, a witness should make a copy of this form on the drive, and complete the report.
- An adult witness should complete this form. If there was no adult witness, an adult should complete this form using direct quotes from a student witness whenever possible.
- Share the Incident Report with the Leader on Duty, who will store it in a secured Google Drive folder
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Milestone Democratic School |
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Incident Report |
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Date |
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Time |
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Students Involved |
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Witnesses |
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Person Completing Form |
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What happened from witness perspective? |
Actions Taken (mark any/all actions taken):
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Parent / Guardian Notified Date & Time: Present on call: Notes: |
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Further Medical Action Taken Notes: |
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CARE Referral Made By Whom: |
Sean Anderson on May 17, 2023
EN 
ES 
HMONG