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Escondido Union ESD |  E  1311  Community Relations

Civility Policy   

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Escondido Union School District

INCIDENT REPORT/CIVILITY POLICY

Name: _____________________________________Site:

Today's Date:

Date and time (approximate) of Incident:

Location of incident (office, classroom, hallway, etc.):

Name of person you are reporting (if known):

Is this person a parent/guardian or relative to a student at EUSD? ____Yes ____No

Did you feel your well-being/safety was threatened? ____Yes ____No

Were there any witnesses to this incident? ____Yes ____No

Name(s) of witness(es): ______________________________________________________

Were the police contacted? ____Yes ____No

Below, please describe what happened: (If you need additional space, please use the back of this sheet. Thank you.)

_______________________________________

Signature of Person Completing Form

A copy of this Incident Report should be sent to the Director, Integrated Student Supports.

ESCONDIDO UNION SCHOOL DISTRICT

revised: November 17, 2016 Escondido, California