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Incident Report for Students Only

CONFIDENTIAL REPORT

This report is confidential and is intended to be submitted to SMCSIG's claims administrator and district's legal counsel for use in recovering losses and defending litigation.
Date and Time of Incident
Month
Day
Year
Time
HoursMinutes
Were they present at the time of the incident?
Was any school rule violated?

Witness

Disposition of Injured After Incident
Time
Time
HoursMinutes
Was the individual told they would be contacted again?
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Date
Month
Day
Year
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