Safe Schools Incident Reporting Forms


Ministry of Education
Report No:
Name of School
1. Name of Student(s)
Involved (if known)
At a location in the school or on school property (please specify)
2. Location of Incident
(check one)
At a school-related activity (please specify) ____________________________________________
On a school bus (please specify route number) _________________________________________
Other (please specify) _____________________________________________________________
3. Time of Incident
Date: _______________________
Time: _____________________
4. Type of Incident
Activities for which suspension must be considered under subsection 306(1) of the Education Act
(check all that apply)
Uttering a threat to inflict serious bodily harm on another person
Possessing alcohol or illegal drugs
Being under the influence of alcohol
Swearing at a teacher or at another person in a position of authority
Committing an act of vandalism that causes extensive damage to school property at the student’s
school or to property located on the premises of the student’s school
Any other activity for which a student may be suspended under board policy
[Note: Boards must specify on this form any other activities for which the principal may suspend
according to board policy.]
Activities for which expulsion must be considered under subsection 310(1) of the Education Act
Possessing a weapon, including possessing a firearm
Using a weapon to cause or to threaten bodily harm to another person
Committing physical assault on another person that causes bodily harm requiring treatment by a
medical practitioner
Committing sexual assault
Trafficking in weapons or in illegal drugs
Committing robbery
Bullying (if the student has been previously suspended for engaging in bullying and the student’s
continuing presence in the school creates an unacceptable risk to the safety of another person)
Any activity listed in subsection 306(1) that is motivated by bias, prejudice, or hate
Giving alcohol to a minor
Any other activity for which a student may be expelled under board policy
[Note: Boards must specify on this form any other activities for which the board may expel according
to board policy.]
5. Report Submitted By:
Role in School Community: ___________________________________________________________________________
Date: _________________
Contact Information: Location: _________________________________________
Telephone: _________________
6. FOR PRINCIPAL’S USE ONLY: Check if incident was a violent incident, as defined in Policy/Program Memorandum No. 120.
Violent incident
Information is collected is under the authority Part XIII of the Education Act in accordance with the Municipal Freedom of Information and Protection of Privacy
Act, and shall be used for the purpose of student discipline. Questions about information collected on this form shall be directed to the school principal.


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