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School Incident Report
School Incident Report
Report Date: [incident_date_display]
State: [_state_name]
Severity: [incident_severity]
[_critical_label]
SECTION 1: INCIDENT DETAILS
Student: ________________ Grade: ________Teacher: ________________
Date: ________________ Time: ________
Location: ________________________________
Severity: ________________
Description:
________________________________
Immediate Actions Taken:
________________________________
SECTION 2: NOTIFICATIONS
Parent / Guardian: Not yet contactedAdministrator: Not yet notified
SECTION 3: PEOPLE INVOLVED
SECTION 4: WITNESSES
No witnesses reported.SECTION 5: ROOT CAUSE ANALYSIS
Contributing Factors:________________________________
Root Cause:
________________________________
Corrective Actions:
________________________________
Preventive Measures:
________________________________
Frequently Asked Questions
School Incident Report