2020欧洲杯在线平台

1/19/2020
select
PERSON REPORTING INCIDENT



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1
NAME OF ALLEGED STUDENT VICTIM
select
2
NAME(S) OF ALLEGED WITNESS(ES) (IF KNOWN)

First Name Last Name Age School
select
Add a witness
3
NAME(S) OF ALLEGED OFFENDER(S) (IF KNOWN)

First Name Last Name Age School Student?
select
Add an offender
4
ON WHAT DATE(S) DID THE INCIDENT HAPPEN?



 
5
CHECK THE STATEMENT(S) THAT DESCRIBES WHAT HAPPENED (CHECK ALL THAT APPLY)
 
6
WHERE DID THE INCIDENT HAPPEN? (CHECK ALL THAT APPLY)
 
7
DESCRIBE THE INCIDENT(S), INCLUDING WHAT THE ALLEGED OFFENDER(S) SAID OR DID.

8
WHY DID THE BULLYING, HARASSMENT OR INTIMIDATION OCCUR?

ADDITIONAL INFORMATION (INJURIES, ETC)
9. Did a physical injury result from this incident? Select one of the following:
10. If there was a physical injury, do you think there will be permanent effects?
11. Was the student victim absent from school as a result of the incident?
12. Did a psychological injury result from this incident? Select one of the following:
13. Is there any additional information you would like to provide?

1/19/2020






 
Maryland State Department of Education in accordance with the Safe Schools Reporting Act of 2005
7-13