Report of Assault on District Employees: GBGB-E

To report assault upon, disorderly conduct toward, harassment of, or any alleged offense under the “Colorado Criminal Code” directed toward a teacher or school employee or instances of damage occurring on School District premises to District property or to the personal property of a school teacher or school employee by a student; please provide the following information:

Date of Report_______________________________________ School____________________________

Student’s Name_________________________________________________Grade__________________

Brief description of reported incident (including dates of incident, time, location):

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Employee Name_____________________________________________________________________

Signature of employee_________________________________________________________________

Witnesses_________________________________________________________________________

Received by (Signature of Administrator)____________________________________________________

Date Received___________________________

Results of Investigation

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_____________________________________________________________________________________

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Copies to:

Employee
Superintendent