Incident Reporting & Student Survey

Name

Email Address

Phone

Please provide the date of the incident.

Type of IncidentReal World / Offline incidentOnline incidentSelect one.

Have you reported this incident to the Police?YesNo

Location of IncidentPlease enter the location of the incident (i.e., name of a school, an address, or location)

Incident DetailsPlease provide as much detail as possible about the incident.

Did a school staff member witness the incident?YesNo

If you answered "Yes" to the previous question, please enter the staff member's name.

Does your child currently feel safe in their school setting?YesNo

If the incident involved physical violence or threat of physical violence, was anyone physically injured?YesNo

Was the immediate handling of the situation satisfactory to you and your child? (i.e. appropriately addressing the perpetrator(s) of the antisemitism, offering your child support, etc)? Please explain.

If the situation was not handled in a satisfactory manner at the time of the incident, did you follow up with the school/administration? If so, please list the titles of the individuals you followed up with (ie. teacher, principal, vice-principal, superintendent, trustee, director of education, etc).

Did you receive a response to your follow up communication? If so, do you feel it appropriately addressed your concerns? Please explain.

Would you be willing to share copies of your correspondence with JPOSA? If yes, please upload it here or forward it to jposaboard@jposa.ca

Please upload any relevant images or videos.

Incident Reporting Form