ACB-R2

 

Incident Report Plan

And Response Plan

Violence and harassment

 

 

Name of person reporting incident:                                                                                                                                 

Date of Incident:                                                                  Date reported:                                                                      

Name of person incident reported to:                                                                                                                                              

Name of person (s) complaint filed against:                                                                                                                   

 

Description of the incident:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               

 

Result of the investigation:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               

 

Response plan:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    

 

o    Team formulates response plan and communicates plan to both parties

 

Options you may include, but not limited to:

 

o    Educational interventions to increase sensitivity/respect

o    Peer mediation

o    Negotiation

o    Behavioral contract

o    Recommendation for disciplinary action

o    Referral to the Superintendent

o    Referral to the Discipline Committee

o    Police Report

 

Name of Individual Preparing report                                                                                

 

Submit this form the Superintendent’s Office within 10 days of the incident.

 

 

 

Adoption Date:                     August 12, 1999

Reviewed/Approved:            May 8, 2008