Volunteer Incident Report Form

Volunteer Incident Report Form
Provide as many details as possible in each section to help expedite the resolution of this incident.
Your Name*

First NameLast Name
Your email*
example@example.com
Date of Incident*

MonthDayYear
Date
Time of Incident*
How many students were involved?*
Student #1*

First NameLast Name (or Initial)
Student #1's Teacher*
Student #2*

First NameLast Name (or Initial)
Student #2's Teacher*
Student #3*

First NameLast Name (or Initial)
Student #3's Teacher*
Student #4*

First NameLast Name (or Initial)
Student #4's Teacher*
Student #5*

First NameLast Name (or Initial)
Student #5's Teacher*
Student #6*

First NameLast Name (or Initial)
Student #6's Teacher*
Student #7*

First NameLast Name (or Initial)
Student #7's Teacher*
Student #8*

First NameLast Name (or Initial)
Student #8's Teacher*
Student #9*

First NameLast Name (or Initial)
Student #9's Teacher*
Student #10*

First NameLast Name (or Initial)
Student #10's Teacher*
Location of Incident*

ClassroomBathroomCafeteriaRecessLunchMiddle School AreaPEField TripGarden AreaOther, please specify
What type of Incident did you support/witness? (Check all that apply)*

Personal Electronic DevicesFightingElopeVandalismBothering peersLitteringInappropriate languageSubstanceTargeting a peerInjuryOther, please specify
Were there any witnesses to the incident?
Strategies *

First aidContacted officeWalked student to officeProblem solved situationConflict resolutionContacted yard duty shift lead for supportContacted Dean of Students for supportOther, please specify
Were the involved students' teachers notified of the incident?*

YesNoMaybe
Please provide information regarding the incident, addressing the three areas listed below:

Antecedent – What happened before the incident occurred?
Strategy Used – What actions or interventions were taken to address the incident?
Incident Details – A clear, factual description of what occurred.
Details of Incident:*
Should be Empty: