Safe Schools Incident Reporting Form - Part I

Ministry of Education | CONFIDENTIAL

Name of School: *

Name of Student(s) Involved (if known):

Location of Incident (check one): *

At a location in the school or on school property

At a school-related activity

On a school bus

Other

please specify *

please specify route number *

Time of Incident

Time: *

Date: *

Type of Incident (check all that apply):

Activities for which suspension must be considered under section 306(1) of the Education Act

Uttering a threat to inflict serious bodily harm on another person

Possessing alcohol or illegal drugs

Being under the influence of alcohol

Swearing at a teacher or at another person in a position of authority

Committing an act of vandalism that causes extensive damage to school property at the student’s school or to property located on the premises of the student’s school

Bullying

Any other activity for which a student may be suspended under board policy [Note: Boards must specify on this form any other activities for which the principal may suspend according to board policy.]

Activities for which explusion must be considered under section 310(1) of the Education Act

Possessing a weapon, including possessing a firearm

Using a weapon to cause or to threaten bodily harm to another person

Committing physical assault on another person that causes bodily harm requiring treatment by a medical practitioner

Committing sexual assault

Trafficking in weapons or in illegal drugs

Committing robbery

Giving alcohol to a minor

Any other activity for which a pupil may be expelled under board policy [Note: Boards must specify on this form any other activities for which the board may expel according to board policy.]

Report Submitted By:

Name: *

Date: *

Contact Information:

Location: *

Telephone: *