"Minor Incident Report Template"

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Presented to: _________________________________Room_____
Location
Be there and prepared
Classroom
On time
Materials
Cafeteria
Drill
Other
Hallway
Homework
Live Responsibly
Bus
Other
Planner
Pride
Steps
Effort
Other
1. Name behavior and
Organization
expectation.
Uphold Integrity
2.Fill out slip.
Honesty
Other
3.Give positive
Good Citizenship
verbal/social acknowledgment
Accountability
4. Give slip to student.
Earn and give respect
5. Remind student to place in
Dress
Self-Control
folder.
Kindness
Other
Courtesy
Given by:______________________________________
Date:__________
Time:___________________
Minor Incident Report
Presented to: _______________________________Room_____
Location
Violation
Classroom
Be there & prepared
Cafeteria
Live Responsibly
Hallway
Uphold Integrity
Bus
Earn & give respect
Consequence
Other
Specific Behavior
Parent Contact
Snail Pass
Detention
Buddy
Room
Department Chair
Other
Steps
1. Name behavior and expectation.
2. State rule and expected behavior.
3. State consequence.
4. Give slip to student.
5. File.
Given by: __________________________________________
Date:__________
Time : _________________
Gotcha!
Presented to: _________________________________Room_____
Location
Be there and prepared
Classroom
On time
Materials
Cafeteria
Drill
Other
Hallway
Homework
Live Responsibly
Bus
Other
Planner
Pride
Steps
Effort
Other
1. Name behavior and
Organization
expectation.
Uphold Integrity
2.Fill out slip.
Honesty
Other
3.Give positive
Good Citizenship
verbal/social acknowledgment
Accountability
4. Give slip to student.
Earn and give respect
5. Remind student to place in
Dress
Self-Control
folder.
Kindness
Other
Courtesy
Given by:______________________________________
Date:__________
Time:___________________
Minor Incident Report
Presented to: _______________________________Room_____
Location
Violation
Classroom
Be there & prepared
Cafeteria
Live Responsibly
Hallway
Uphold Integrity
Bus
Earn & give respect
Consequence
Other
Specific Behavior
Parent Contact
Snail Pass
Detention
Buddy
Room
Department Chair
Other
Steps
1. Name behavior and expectation.
2. State rule and expected behavior.
3. State consequence.
4. Give slip to student.
5. File.
Given by: __________________________________________
Date:__________
Time : _________________