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INCIDENT REPORT - ELEMENTARY
SCHOOL:
DATE:
DATE AND TIME OF INCIDENT:
SIGNATURE OF PRINCIPAL:_____________________________________
The purpose of this report is to give a brief description of any “incident” occurring in
your building, parking lot, etc. Submit a copy of this report to the Superintendent and
Elementary Office as soon as possible after the incident.
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LOCATION OF INCIDENT (I.E., PARKING LOT, CLASSROOM, ETC.):
NAME OF INDIVIDUALS INVOLVED IN THE INCIDENT AND THEIR CAPACITY (I.E., STUDENT, TEACHER,
CUSTODIAN, ETC.):
DESCRIPTION OF INCIDENT: