Safety Input Form

Safety Input Form
Important Note: This form is intended for reporting safety concerns. If you are reporting an emergency situation that requires immediate attention, please contact 911.

Please note that if you submit input anonymously, you will NOT receive follow-up to your submission.
Name (Optional)

First NameLast Name
Email (Optional)
example@example.com
School / Site:*

Alder Elementary SchoolDavis Elementary SchoolFairview Elementary SchoolHartley Elementary SchoolMargaret Scott Elementary SchoolSalish Ponds Elementary SchoolSweetbriar Elementary SchoolTroutdale Elementary SchoolWilkes Elementary SchoolWoodland Elementary SchoolH.B. Lee Middle SchoolReynolds Middle SchoolWalt Morey Middle SchoolReynolds High SchoolReynolds Learning AcademyNutrition ServicesTechnology ServicesFacilities & Transportation ServicesEdgefield Bldg AEdgefield Bldg IEdgefield Bldg J
Specific location of incident / concern: (e.g. gym, classroom #, etc)*
Date of Incident Occurred:*

MonthDayYear
Date
Time Incident Occurred:*

Hour Minutes

AM/PM Option
Detail the incident:*
Did you take any immediate action in response to the incident / concern: (e.g. reported to school administrator or supervisor, intervened directly, etc.)*
Should be Empty: