Date:
Location of Incident : (eg. Bus, Meco’s, School hallways, bathrooms, locker rooms etc.)
People Involved:
Describe Incident: (What happened? Give details including any injuries or loss or damage to property. If possible give names of all people involved, including witnesses.)
Has anything like this ever happened before? Yes No If yes, please give details, including times and dates:
What do you think was the cause of the event?
