School Incident Report Form for Teachers Example – [Edit & Download]
Date and Time of Incident: April 5, 2025, at 2:00 PM
Location of Incident: Gymnasium, Oakwood Academy
Person Reporting the Incident: Thomas Green, Physical Education Teacher
Details of Involved Individuals:
- Sophia Larson – Student, Grade 9
- Evan Turner – Student, Grade 9
- Isabella Martinez – Student, Grade 9
Witnesses:
- Rachel Adams – Assistant PE Teacher
- Kyle Brown – Student, Grade 9
Description of Incident:
During a dodgeball game, a verbal altercation broke out between Sophia Larson and Evan Turner, which escalated quickly when Isabella Martinez attempted to intervene. The argument turned physical when Evan shoved Isabella, causing her to fall and sustain a minor injury.
Immediate Actions Taken:
- The game was stopped, and all students were asked to sit down.
- First aid was administered to Isabella Martinez by the school nurse.
- Sophia Larson and Evan Turner were taken to the principal’s office.
- Parents of the involved students were notified and asked to come to the school.
Follow-up Actions:
- Conduct individual counseling sessions with Sophia, Evan, and Isabella to address the behavior and underlying issues.
- Hold a class discussion about sportsmanship and the importance of respecting peers.
- Review and reinforce school policies on conflict resolution and physical confrontations with all students.
- Arrange a meeting with the parents of the involved students to discuss the incident and planned interventions.
Signatures:
- Thomas Green (Reporter)
- Elizabeth Warren (Principal)
Additional Notes:
Isabella Martinez reported slight pain but no serious injury; she was sent home with her parents following a medical evaluation. An investigation into the cause of the altercation will be conducted to understand the dynamics between the students better and to prevent future incidents. Additional supervision will be provided during gym classes to ensure a safe environment for all students.
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School Incident Report Form for Teachers Example – [Edit & Download]
Date and Time of Incident: April 5, 2025, at 2:00 PM
Location of Incident: Gymnasium, Oakwood Academy
Person Reporting the Incident: Thomas Green, Physical Education Teacher
Details of Involved Individuals:
Sophia Larson – Student, Grade 9
Evan Turner – Student, Grade 9
Isabella Martinez – Student, Grade 9
Witnesses:
Rachel Adams – Assistant PE Teacher
Kyle Brown – Student, Grade 9
Description of Incident:
During a dodgeball game, a verbal altercation broke out between Sophia Larson and Evan Turner, which escalated quickly when Isabella Martinez attempted to intervene. The argument turned physical when Evan shoved Isabella, causing her to fall and sustain a minor injury.
Immediate Actions Taken:
The game was stopped, and all students were asked to sit down.
First aid was administered to Isabella Martinez by the school nurse.
Sophia Larson and Evan Turner were taken to the principal’s office.
Parents of the involved students were notified and asked to come to the school.
Follow-up Actions:
Conduct individual counseling sessions with Sophia, Evan, and Isabella to address the behavior and underlying issues.
Hold a class discussion about sportsmanship and the importance of respecting peers.
Review and reinforce school policies on conflict resolution and physical confrontations with all students.
Arrange a meeting with the parents of the involved students to discuss the incident and planned interventions.
Signatures:
Thomas Green (Reporter)
Elizabeth Warren (Principal)
Additional Notes:
Isabella Martinez reported slight pain but no serious injury; she was sent home with her parents following a medical evaluation. An investigation into the cause of the altercation will be conducted to understand the dynamics between the students better and to prevent future incidents. Additional supervision will be provided during gym classes to ensure a safe environment for all students.