Christian Educators Association International Resources for Christian Educators in Private & Public Schools
A Professional Association for
Christians in Public and Private Schools
Phone: 888.798.1124
Home   RESOURCES Member Incident Report Form
Become a Member/Access Your Account-> Become a member today
Check Our Fees

tipps

CEAI Christian Educators Association International TIPPS Podcast

ECFA - A higher standard - A higher purpose

Commitment to Transparency - Recognized by Intelligent Philanthropy

Tuesdays With Karen

Tuesdays With Karen
Incident Report Form
Hits smaller text tool iconmedium text tool iconlarger text tool icon

Incident Report Form

Complete all fields
Name (*)
Missing Information
Address (*)
Missing Information
City (*)
Missing Information
State (*)
Missing Information
Zip (*)
Missing Information
Home Phone (*)
Missing Information
Work Phone
Invalid Input
School Name (*)
Missing Information
Grade Level (*)
Missing Information
Subject Teaching (*)
Missing Information
E-mail (*)
This field is required and must be a valid email address

Please complete the following as it applies to your circumstances
Is this a report of a job action involving your position?

Invalid Input
If NO, but you are reporting a possible liability claim, answer ALL QUESTIONS below. Attach copies of any documentation you have. If YES, answer questions 1 and 2, skip 3 and 4 if appropriate, and fill in the Brief Description Section below. Attach copies of any documentation you have.

Narrative of Report:
Date of notice/incident
Invalid Input
Time of notice/incident
Invalid Input
Names of witnesses
Invalid Input
Location of incident
Invalid Input
Age of Child
Invalid Input
Sex of child
Invalid Input
Grade level of child
Invalid Input
Brief description of notice/incident in chronological order:
Invalid Input
Image Verification Image Verification
Refresh
Invalid Image Verification
  

icon Download form in PDF format to fill out, print and mail (61.26 kB)
 
Back To Top
developed by infiniti web design