Misconduct or Safety Concern Report

Misconduct or Safety Concern Report

To report an incident of alleged misconduct or a safety concern—including harassment, discrimination, retaliation, hazing, bullying, or aggressive behavior—please complete this form as thoroughly and accurately as possible. If you wish to remain anonymous, you may enter “Anonymous” under the Reporter Name section. Other reporting options: A paper form is available in the School Office and through Student Services. If you or someone you know is struggling with mental health, please text or call 988.
CONFIDENTIAL

This form is confidential and protected under law. Please provide as much detail as possible. You may choose to include your name, or make the report anonymously.
Name of alleged victim(s).*
Grade of alleged victim.
Name of the accused(s).*
Grade of the accused.
Time of alleged incident.

Hour Minutes

AM/PM Option
Date of alleged incident.*

MonthDayYear
Where did the incident occur?
Please describe, in as much detail as possible, what happened.
OPTIONAL: If you are not a student at SJDA, will you please provide your contact information? Please include your name, email, and/or phone number.
Has anyone been informed of this behavior? Any Teachers, school administrator, law enforcement officials, parents/guardians, etc. Please explain.*
Thank you for filling out The Misconduct or Safety Concern Reporting Form.

All reports will be investigated.

The investigator will make separate, private interviews with:the reporter, the accused, and any witnesses named by the reporter or the accused.

Retaliation against complainants is absolutely forbidden. The penalties for retaliation could result in expulsion.
Should be Empty:

Misconduct or Safety Concern Report

CONFIDENTIAL