If you are human, leave this field blank.Safe Schools Incident Reporting Form - Part IMinistry of Education | CONFIDENTIALName of School: *AmethystBloomsburgBoston PublicCaledonia CentennialCayuga SecondaryCourtlandDelhi District SSDelhi PublicEcole Ste. MarieFanshawe CollegeHagersville ElementaryHagersville SecondaryHoly TrinityHoughtonJ. L. MitchenerJarvis PublicLakewood ElementaryLangton PublicMcKinnon Park, CaledoniaNotre DameOur Lady of FatimaPort RowanRainham CentralRiver HeightsRobartsSacred HeartSimcoe Composite SSt Cecilia'sSt Patrick'sSt. FrancesSt. JosephSt. Michael's, DunnvilleSt. Michael's, WalshSt. Stephen'sThompson CreekValley HeightsW. Ross McDonaldWalsh PublicWaterford District SSWest LynnName of Student(s) Involved (if known):Location of Incident (check one): *At a location in the school or on school propertyAt a school-related activityOn a school busOtherplease specify *please specify *please specify *please specify route number *B658H501H502H517H518H522H524H525H526H541H542H543H544H545H546H547H554H555H556H557H558H559H580H581H582H584H586N500N501N502N503N515N516N520N521N522N523N524N525N526N530N531N532N533N534N535N540N541N542N543N544N545N546N547N548N550N551N552N553N555N556N557N558N559N560N562N563N571N572N573N574N575N580N581N582N583N584N585N586N587N588N590N591N592N594N596N597N600N601N602N603N604N605N606N607N608N609N610N611N612N613N614N615N617N619N620N621N622N623N624N625N626N658N660N661N662N665N667N668N669N670N671N672N673N674N675N682N683 Time of IncidentTime: *Date: * Type of Incident (check all that apply):Activities for which suspension must be considered under section 306(1) of the Education ActUttering a threat to inflict serious bodily harm on another personPossessing alcohol or illegal drugsBeing under the influence of alcoholSwearing at a teacher or at another person in a position of authorityCommitting 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 schoolBullyingAny 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 ActPossessing a weapon, including possessing a firearmUsing a weapon to cause or to threaten bodily harm to another personCommitting physical assault on another person that causes bodily harm requiring treatment by a medical practitionerCommitting sexual assaultTrafficking in weapons or in illegal drugsCommitting robberyGiving alcohol to a minorAny 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: *Submit Form