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PR 515 SCO - Appendix A-OCDSB 515 Part I Safe Schools Incident ReportingAppendix A to PR.515.SCO OCDSB 515-Part I Reporting - School Operations (updated 2019) SAFE SCHOOLS INCIDENT REPORTING FORM – PART I OF II (References: Bill 157, Ministry of Education PPM 144 and 145, and OCDSB Policy P.026.SCO and Procedure PR.515.SCO) Additional documentation / information relating to the incident may be attached to this form if required. Report No: ________ CONFIDENTIAL INCIDENT REPORTING FORM – PART I Name of School 1. Name of Student(s) Involved (if known) ________________________________________ ________________________________________ 2. Location of Incident (check one) ☐ At a location in the school or on school property (please specify) _________________________________________________ ☐ At a school-related activity (please specify) ________________________________________________________ ☐ On a school bus (please specify route number) ________________________________________________________ ☐ Other (please specify) ___________________________________________________ 3.Time of Incident Date: __________ Time: __________Location: __________ 4. Type of Incident (check all that apply) Activities for which suspension must be considered under section 306(1) of the Education Act and Board Procedure PR.515.SCO ☐ uttering a threat to inflict serious bodily harm on another person; ☐ possessing alcohol, illegal drugs or cannabis; ☐ being under the influence of alcohol or cannabis; ☐ swearing at a teacher or another person in a position of authority; ☐ committing an act of vandalism that causes extensive damage to school property or to property located on the premises of the student’s school; ☐ bullying; ☐ persistent opposition to authority; ☐ habitual neglect of duty as a student as defined by the Education Act, District or school policies; OCDSB 515-Part I Reporting - School Operations (updated 2019) ☐ willful destruction or theft of school property or property located on school premises; ☐ profane or improper language; ☐ conduct injurious to the physical or mental well-being of others; ☐ inappropriate use of information technology, as defined in Board policies and procedures; ☐ smoking/vaping on school/District premises; ☐ possessing, selling or providing illegal drugs and/or alcohol; ☐ distributing any tobacco or vaping products; ☐ being under the influence of illegal drugs; or ☐ any act considered to be contrary to the Board or school code of conduct. Activities for which a student must be suspended from their school and all school-related activities for up to 20 school days, pending an investigation under section 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 illegal drugs; ☐ committing robbery; ☐ giving alcohol or cannabis to a minor; ☐ bullying, if, ☐ the student has previously been 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 as a possible reason for suspension in subsection 306 (1) that is motivated by bias, prejudice or hate based on race, national or ethnic origin, language, colour, religion, sex, age, mental or physical disability, sexual orientation, gender identity, gender expression, or any other similar factor; and ☐ another activity for which a principal must suspend, and, therefore in accordance with this Policy, conduct an investigation to determine whether to recommend to the board that the student be expelled. 5. Report Submitted By: Name: ______________________________________________________________________ Signature:_________________________________________ Date: _________________ (Original signature is required) Contact Information: Location: _______________________ Telephone: