Date:  __________________________________

Student Name: ___________________________

Time of Incident: __________________________

Describe in detail what happened and why, in your opinion, it happened.

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Did anyone else see what happened? ___________________________________________________

Was anyone hurt? _________________________________________________________________

What strategies could have been used in order to avoid this incident?

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STAFF Notes: _____________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

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1, 2, 3, 4, 5, 6, 7, 8, 9, 10 Table of Contents, ii, iii, iv, Back to Teacher’s Binder, Home
Interactive Sample: 1, 2

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