Hot Springs School District

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Please complete this form to the best of your knowledge so we can assist you.
This information will be kept confidential with your campus administrator and/or superintendent.

Please Fill Out The Safety Alert Below

Date of Incident:

Date of Report:

Who were the people involved in the incident?

What type of incident was this?

Physical

Emotional/Social

Damage to Property

Online

Bullying

Other:

Other location details about the situation: (Please explain the specific school and location details such as which hallway, where on the Internet, what restroom, etc)

Describe what happened with as many details as possible.

Person reporting the incident:(OPTIONAL). Please use your full name and include an email or phone number for follow up.

May we contact you for more information on this incident?

Yes

Thank you for reporting this incident. We appreciate your concern. When you click "Submit Form" this will be sent to Chief Seymour and then shared with administrators and superintendents as appropriate.

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