Incident Report Suspected Abuse

Incident Report

Suspected Abuse


Name of Student Involved:                                                                                                                                                            




Birthdate:                                                  Male                          Female                                                                         


Parent or Guardian:                                                                                                     Phone:                                    






Name of Alleged Abuser:                                                                                                                                                               


Date and Place of Incident or Incidents:                                                                                                               




Description of Misconduct (Attach report if necessary):                                                                             
















Name of Witnesses (Complete witness report):                                                                                                                





Other Information (Inc. evidence of abuse, i.e. letters, photos, etc.):            








I agree that all of the information on this form is accurate and true to the best of my knowledge.



Signature of Investigator                                                                                          Date


Witness Disclosure Form


Name of Witness:                                                                                                                                                                                


Position of Witness:                                                                                                                                                         


Date of Testimony, Interview:                                                                                                                                     


Description of Instance Witnessed (Attach report if necessary):






















Other Information:












I agree that all of the information on this form is accurate and true to the best of my knowledge.



Signature of Witness                                                                                                  Date