Tracking Report Form #20

Behavioral Incident Report
2004-2005 School Year

District :    
School :   Last Updated on
Grade Insubordination Harassment
  Male Female   Male Female
# Inc New Rpt New Rpt # Inc New Rpt New Rpt
K
1
2
3
4
5
6
7
8
9
10
11
12
Totals









Grade Bullying Vandalism
  Male Female   Male Female
# Inc New Rpt New Rpt # Inc New Rpt New Rpt
K
1
2
3
4
5
6
7
8
9
10
11
12
Totals

1. Insubordination includes verbal abuse, failure to follow verbal instructions and/or requests.
2. Harassment includes conduct whether verbal, written, graphic, or physical relating to studentís race, national origin, color, disability or sex that is sufficiently severe, pervasive or persistent.
3. Bullying is defined as intentional, repeated hurtful acts, words or other behavior such as name-calling, threatening and/or shunning committed by one or more children against another. Bullying may be physical, verbal, or emotional in nature.
4. Vandalism includes disrespect, destroying, defacing property and/or buildings.

Directions:
       A. # Incident (Incid) = total number of incidents that occur per grade
       B. Male or Female = number of individuals involved in each incident by gender
       C. New = first offense by student
       D. Repeat (Rpt) = second/additional offenses by same student