Document IDINCIDENT1 | TitleIncident Report | Print Date9/15/22 |
Revision1.0 | Prepared ByOperations and Governance Circle | Date Prepared9/15/22 |
Effective Date9/15/22 | Reviewed By Operations and Governance Circle | Date Reviewed9/15/22 |
Approved ByOperations and Governance Circle | Date Approved9/15/22 |
Process:
- Once the situation is non-emergent, a witness should make a copy of this form on the drive, and complete the report. Witness can either print and complete a paper copy, or fill it out electronically to print and delete for confidentiality.
- 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.
- Once the form is complete, make a copy for every student involved, and send it home to the family.
- Give the original form to Kate or Stefano to file in the Incident Report Binder.
- If you completed electronically, please delete the file so that we can maintain confidentiality.
Milestone Democratic School |
Incident Report |
Date | |
Time | |
Students Involved | |
Witnesses | |
Person Completing Form |
What happened from witness perspective? |
Actions Taken (mark any/all actions taken):
Parent Notified Notes: | |
Further Medical Action Taken Notes: | |
Restorative Justice Referral Made By Whom: |