Tracking Report Form #18

Substance Incident Report
2004-2005 School Year

District :    
School :   Last Updated on
Grade Tobacco Alcohol Other Drugs
  Distribution Use Possession Distribution Use Possession Distribution Use Possession
K
1
2
3
4
5
6
7
8
9
10
11
12
Totals

Alcohol - Any product containing at least 0.5 alcohol by volume or weight. Examples include beer, wine and spirits (vodka, gins, whiskey, etc.)
Tobacco - A product containing tobacco in any form
Other Drugs - A substance regulated by the Controlled Substances Act, examples, marijuana, meth, PCP, designer drugs, heroin, etc.

Distribution: includes sale and/or providing alcohol, tobacco or drugs to another while on school campus or at school sponsored activities
Use: means use on school campus or at school-sponsored activities.
Possession: means drugs, alcohol, or tobacco carried by a student while on the school campus or at school sponsored activities.