Report An Incident

Afton CSD - DASA Incident Reporting

I have read and understand the confidentiality statement.
Name of student or staff target:
Name of alleged aggressor(s):
Name of Witness(es):
Where did the incident(s) happen (choose all that apply)?

Other Description:
What best described what happened (choose all that apply)?

What did the alleged aggressor(s) say or do. Please include the class, date, and time for each occurrence.
Did a physical injury result from the incident?

Is there any additional information that you would like to provide?
Name of person reporting (optional):
Phone Number:
Email Address:
Please check the appropriate space:

To validate your submission, please answer the following math problem:

2 + 2 =
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