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Workplace Violence Incident Report
Workplace Violence Incident Report
Report submitted by:
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Person filling out this form
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Reporter Status
*
Answer Required
Student or former student
BVUSD Employee or former employee
Parent
Reporter First Name
*
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Reporter Last Name
*
Answer Required
Reporter email
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Reporter phone
Number Required
Report date:
*
Date incident was reported
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Incident date:
*
Date incident occurred
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Time incident occurred
*
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Address/Location of incident
*
Answer Required
Describe the incident
*
State what was said/done. Use specific language if applicable. Include dates, times, locations, and names of witnesses.
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Upload any additional information about the incident
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Choose a file
or drag it here.
Assailant Information
Assailant Status
*
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Student or former student
Employee or former employee
Parent
Stranger
First name of alleged assailant
if known
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Last Name of alleged assailant
if known
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Nature of Incident
*
(add details below)
Answer Required
1) Stalking
2) Fright, coercion, or duress
3) Destruction of property
4) Hitting, fighting, pushing or shoving
5) Use of object as weapon
6) Use of weapon
7) Verbal harrassment
8) Sexual harrassment
9) Other
Nature of incident details
Reference by category number above to add details. For example 6) knife
Answer Required
Confirmation Email
Confirmation Email
Email Required
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