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<br /> <br />SSIRF–PIII <br />AFE CHOOLS NCIDENT EPORTING ORM ART OF <br />(References: Bill 157: Education Amendment Act (Keeping Our Kids Safe <br />at School Act), 2009 <br /> <br />Ministry of Education Policy and Program Memoranda (PPM) 144 and 145 <br />OCDSB Policies P.020.SCO, P.026.SCO and <br />Procedures PR.511.SCO and PR.515.SCO) <br /> <br /> <br />Reference the above-noted policies and procedures and page three for background and instructions on completing this form, <br />responsibilities of individual reporting the incident / activity and the principal, and distribution requirements as set out in the <br />Ministry of Education’s PPM 144 and 145. <br /> <br />Additional documentation / information relating to the incident may be attached to this form if required. <br /> <br /> CONFIDENTIAL <br /> <br />Report No: ________ <br />SAFE SCHOOLS INCIDENT REPORTING FORM – PART I (REPORTING) <br /> <br /> <br />Name of School <br /> <br /> <br />1. Name of Student(s) <br /> <br />Involved (if known) <br />_______________________________________________________________________________ <br /> <br /> <br /> <br /> <br />_______________________________________________________________________________ <br /> <br /> <br /> <br /> <br />2. Location of Incident <br />At a location in the school or on school property (please specify) <br />(check one) <br />___________________________________________________________________________ <br /> <br /> <br />At a school-related activity (please specify) <br />___________________________________________________________________________ <br /> <br /> <br />On a school bus (please specify route number) <br />___________________________________________________________________________ <br /> <br /> <br />Other (please specify) ___________________________________________________ <br /> <br />3.Time of Incident <br /> <br />Date: _________________ Time: ________ Location: _____________________ <br />4. Type of Incident Activities for which suspension must be considered under section 306(1) of the Education Act <br />(check all that apply) <br /> <br />Uttering a threat to inflict serious bodily harm on another person <br /> <br /> <br />Possessing alcohol or illegal drugs <br /> <br />Being under the influence of alcohol <br /> <br />Swearing at a teacher or at another person in a position of authority <br /> <br />Committing an act of vandalism that causes extensive damage to school property at the student’s <br />school or to property located on the premises of the student’s school <br /> <br />Bullying <br /> <br /> <br />For this reporting purposes, the following other activities for which a student may be suspended <br />under board policy: <br /> <br /> <br />committing an act of vandalism that causes damage to District property or to property located on <br />the premises of the District <br /> <br /> possession or sale of illegal or unauthorized tobacco products, prescription drugs and alcohol <br /> <br /> <br />being under the influence of illegal drugs <br /> <br /> <br /> <br />OCDSB 515-Part I Reporting School Operations (May 2010) <br /> <br />