Elementary School Incident Report Form Example – [Edit & Download]
Date and Time of Incident: February 24, 2025, at 10:15 AM
Location of Incident: Playground, Maple Elementary School
Person Reporting the Incident: Sarah Collins, Playground Supervisor
Details of Involved Individuals:
- Lucas Brown – Student, Grade 2
- Emma Wilson – Student, Grade 2
Witnesses:
- Natalie Ford – Teacher, Grade 2
- Jack Roberts – Playground Assistant
Description of Incident:
During recess, Lucas Brown and Emma Wilson were involved in a dispute over playground equipment. The disagreement escalated when Lucas pushed Emma, causing her to fall and scrape her knee.
Immediate Actions Taken:
- Both students were immediately separated to cool down.
- First aid was applied to Emma Wilson’s scraped knee by the school nurse.
- Lucas Brown was taken aside to discuss his actions and the importance of sharing and kindness.
Follow-up Actions:
- A meeting with both students’ parents to discuss the incident and explore strategies to prevent future conflicts.
- Additional monitoring of playground interactions, with a focus on teaching conflict resolution skills to students.
- A reminder session for all students about playground rules and the importance of respecting each other.
Signatures:
- Sarah Collins (Reporter)
- Michael Thompson (Principal)
Additional Notes:
Emma Wilson was comforted and returned to class after treatment; her parents were informed of the incident. Lucas Brown expressed remorse for his actions and participated in a restorative conversation with Emma. The school will continue to reinforce positive behavior and interactions among students to ensure a safe and nurturing environment.
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Elementary School Incident Report Form Example – [Edit & Download]
Date and Time of Incident: February 24, 2025, at 10:15 AM
Location of Incident: Playground, Maple Elementary School
Person Reporting the Incident: Sarah Collins, Playground Supervisor
Details of Involved Individuals:
Lucas Brown – Student, Grade 2
Emma Wilson – Student, Grade 2
Witnesses:
Natalie Ford – Teacher, Grade 2
Jack Roberts – Playground Assistant
Description of Incident:
During recess, Lucas Brown and Emma Wilson were involved in a dispute over playground equipment. The disagreement escalated when Lucas pushed Emma, causing her to fall and scrape her knee.
Immediate Actions Taken:
Both students were immediately separated to cool down.
First aid was applied to Emma Wilson’s scraped knee by the school nurse.
Lucas Brown was taken aside to discuss his actions and the importance of sharing and kindness.
Follow-up Actions:
A meeting with both students’ parents to discuss the incident and explore strategies to prevent future conflicts.
Additional monitoring of playground interactions, with a focus on teaching conflict resolution skills to students.
A reminder session for all students about playground rules and the importance of respecting each other.
Signatures:
Sarah Collins (Reporter)
Michael Thompson (Principal)
Additional Notes:
Emma Wilson was comforted and returned to class after treatment; her parents were informed of the incident. Lucas Brown expressed remorse for his actions and participated in a restorative conversation with Emma. The school will continue to reinforce positive behavior and interactions among students to ensure a safe and nurturing environment.