Incident Reporting Form

THE CITY OF LAKE FOREST · SCHOOL DISTRICT #67 · LAKE FOREST, ILLINOIS

ONLINE INCIDENT REPORTING FORM

IMPORTANT: Incidents reported through this system will be reviewed by staff ONLY DURING SCHOOL HOURS and is just for the use of Deer Path Middle School students and parents.

DO NOT USE THIS SYSTEM TO REPORT EMERGENCIES THAT REQUIRE IMMEDIATE ATTENTION – Call 911.

If you need an additional resource contact the Lake County Crisis Center 847-377-8088

Name and School Please complete the information in this section.

NOTE: Your name is NOT REQUIRED to complete this form; however, it is encouraged as a means to follow up as necessary.

Name		School
		Are you a Student Parent

Incident Report
Describe what happened.

Where did this happen?

When did this happen?

Who was involved in this situation?

If it's someone you know please fill in their name below.

Did anyone else see what happened if so who?

Was this a one time incident or part of a bigger problem?

How did it make you feel?

Was the person physically hurt? Yes No

Have you told anyone about this? Yes No

If you have not told anyone what has stopped you?

What sort of help would you like to stop it?

Do you have any worries now that you have reported the incident?