PERSONNEL
402.3E1 - ABUSE OF STUDENTS BY SCHOOL DISTRICT EMPLOYEES REPORT FORM
Complaint of Injury to or Abuse of a Student by a School District Employee
Please complete the following as fully as possible. If you need assistance, contact the Level I investigator in your school.
Student's name and address
Student's telephone no.:
Student's school:
Name of employee accused of abusing student:
Allegation is of physical sexual abuse*
Please describe what happened. Include the date, time and where the incident took place, if known. If physical abuse is alleged, also state the nature of the student's injury:
*Parents of children who are in pre-kindergarten through sixth grade and whose children are the alleged victims of or witnesses to sexual abuse have the right to see and hear any interviews of their children in this investigation. Please indicate "yes" if the parent/guardian wishes to exercise this right:
Yes No Telephone Number