DASA
Afton CSD - DASA Incident Reporting
I have read and understand the confidentiality statement.
Name of person reporting (optional):
Name of target (student being bullied, harassed, or discriminated against):
Name of alleged offenders(s):
Date(s) and time(s) of incidents(s):
What was your involvement in the incident?
Type of incident (check all that apply)?
Describe the specific nature of the incident. What happened? (Be as specific as possible). What did the alleged offender(s) say or do? Include any copies of text messages, emails, etc. if possible.
If there were any adults in the area when this happened, what did they do?
Names of others who may have witnessed the incident:
Was the student absent from school as a result of the incident?
Number of days student was absent:
Does the situation continue to occur?
What do you think should be done about the situation?