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Incident Report

indicates a required answer

Glen Rose Christian Co-op

Incident Report
1. *

Reporter's Name
2. *

Child's Name
3. *

Location the incident occured
4. *

Date of the incident
5. *

Approximate time of the incident
6. *

Were there any other children directly involved?

 (1 required)
Yes No
7. 

If yes, name the other student(s) involved
8. *

Describe the incident - state only facts
9. *

Were there any changes or consequences put in place? If so, what?
10. *

Were parents contacted? If so, by what means? 

 (1 required)
No Phone Call
Email Text
11. *

Was admin notified? If so, how?

 (1 required)
No Phone Call
Email Text
In- person
12. *

Was the incident witnessed by any other adults?

 (1 required)
Yes No
13. 

If yes, whom?
14. *

Is any other follow-up recommended at this time? 

 (1 required)
Yes No
15. 

What would your recommendation for follow-up be? 
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