CLASSROOM INCIDENT REPORT ____________________________________(Student’s name) has been instructed to report to the office of the Senior Teacher, Deputy Principal/Principal for:
Repeated failure to comply. Speaking disrespectfully. Refusing to do class work. Using profanity. Being continually off task. Engaging in disruptive behavior. Harassing classmates. Endangering the safety of others. Coming to class unprepared. Arguing with the teacher or talking back. Leaving the classroom without permission. Refusing to leave the classroom upon request. Possession of a weapon. Wearing inappropriate clothing. Wearing the school uniform inappropriately. Physical aggression or fighting. Destroying school/student/teacher property. Using threats.
Other: _________________________________________________ _________________________________________________ Warnings have been given…
Yes
No
Action taken by teacher includes… ____________________________________ ________________________________________________________________ _________________________________________________________________ _____
The student cooperated and complied immediately.
_____
The student did not cooperate and refused to proceed to the office.
Teacher: _______________________ Date:______________________ 46 Time: _____________ Period: ______
