NOTICE OF STUDENT INCIDENT REPORT

Name: Year: Teacher:

Date: Location:

Report of Incident:

Being rude or disrespectful Speaking in a discourteous tone

Did not follow repeated teacher Hitting/striking another student

Instructions
Fighting / Bullying Used bad language

Disturbing other students Involved in rough play

Throwing a dangerous projectile Homework/Uniform

Other:___________________________

Description of Incident:

As a result, the following action has been taken

Teacher Signature: _____________________________

Pastoral Care Signature: _______________________ Principal: ______________

“Every child will experience amazing learning, love school, and

make great progress.”