Reportable Behaviour Report Form Please enable JavaScript in your browser to complete this form. - Step 1 of 2District *School District 5 Southeast KootenaySchool District 6 Rocky MountainSchool District 8 Kootenay LakeSchool District 10 Arrow LakesSchool District 19 RevelstokeSchool District 20 Kootenay-ColumbiaSchool District 22 VernonSchool District 23 Central OkanaganSchool District 27 Cariboo-ChilcotinSchool District 28 QuesnelSchool District 33 ChilliwackSchool District 34 AbbotsfordSchool District 35 LangleySchool District 36 SurreySchool District 37 DeltaSchool District 38 RichmondSchool District 39 VancouverSchool District 40 New WestminsterSchool District 41 BurnabySchool District 42 Maple Ridge-Pitt MeadowsSchool District 43 CoquitlamSchool District 44 North VancouverSchool District 45 West VancouverSchool District 46 Sunshine CoastSchool District 47 Powell RiverSchool District 48 Sea to SkySchool District 49 Central CoastSchool District 50 Haida GwaiiSchool District 51 BoundarySchool District 52 Prince RupertSchool District 53 Okanagan SimilkameenSchool District 54 Bulkley ValleySchool District 57 Prince GeorgeSchool District 58 Nicola-SimilkameenSchool District 59 Peace River SouthSchool District 60 Peace River NorthSchool District 61 Greater VictoriaSchool District 62 SookeSchool District 63 SaanichSchool District 64 Gulf IslandsSchool District 67 Okanagan SkahaSchool District 68 Nanaimo-LadysmithSchool District 69 QualicumSchool District 70 AlberniSchool District 71 Comox ValleySchool District 72 Campbell RiverSchool District 73 Kamloops/ThompsonSchool District 74 Gold TrailSchool District 75 MissionSchool District 78 Fraser-CascadeSchool District 79 Cowichan ValleySchool District 81 Fort NelsonSchool District 82 Coast MountainsSchool District 83 North Okanagan-ShuswapSchool District 84 Vancouver Island WestSchool District 85 Vancouver Island NorthSchool District 87 StikineSchool District 91 Nechako LakesSchool District 92 Nisga'aSchool District 93 Conseil scolaire francophoneLocation *If the location list is empty, you are not yet set up to use this form. Please return to the Forms page and select "Request form set up for your District"SD 35 Location *Alice Brown ElementaryAldergrove Community SecondaryAlex Hope ElementaryBelmont ElementaryBlacklock Fine Arts ElementaryBetty Gilbert MiddleBrookswood SecondaryCoghlan Fundamental ElementaryDouglas Park Community ElementaryDorothy Peacock ElementaryD.W. Poppy SecondaryFacilities, Maintenance and TransportationFort Langley ElementaryGlenwood ElementaryGordon Greenwood ElementaryH.D. Stafford MiddleJames Hill ElementaryJames Kennedy ElementaryLangley Education CentreLangley Fine Arts SchoolLangley Fundamental ElementaryLangley Fundamental Middle/SecondaryLangley Meadows CommunityLangley Secondary SchoolLynn Fripps ElementaryOtherNoel Booth ElementaryNicomekl ElementaryNorth Otter ElementaryParkside Centennial ElementaryPeter Ewart MiddlePeterson Road ElementaryR.C. Garnett Demonstration ElementaryR.E. Mountain SecondaryRichard Bulpitt ElementarySchool Board OfficeShortreed Community ElementarySimonds/U-Connect ElementaryTopham ElementaryUplands ElementaryVanguard SecondaryWix-Brown ElementaryWilloughby ElementaryWalnut Grove SecondaryWest Langley ElementaryYorkson Creek Middle SchoolSD36 Location *A.H.P. MatthewA.J. McLellanAdams RoadBayridgeBear CreekBeaver CreekBerkshire ParkBetty HuffBonaccordBothwellBoundary ParkBridgeviewBrooksideCambridgeCedar HillsChantrell CreekChimney HillCindrichCity Central Learning CentreClaytonClayton HeightsCloverdale Learning CentreCloverdale TraditionalCoast MeridianColebrookCougar CreekCoyote CreekCreeksideDavid BrankinDogwoodDon ChristianDr. F.D. SinclairÉcole Earl MarriottÉcole Kwantlen ParkÉcole Lord TweedsmuirÉcole Panorama RidgeÉcole SalishEast KensingtonÉcole Crescent ParkÉcole Erma StephensonÉcole Fraser WoodÉcole Frost RoadÉcole Henry BoseÉcole Jessie LeeÉcole K.B. WoodwardÉcole LarondeÉcole Martha CurrieÉcole Ocean CliffÉcole Peace ArchÉcole RiverdaleÉcole Simon CunninghamÉcole Sunrise RidgeÉcole Woodward HillEducation Services SchoolElgin ParkEllendaleEnver CreekFleetwood ParkForsyth RoadFrank HurtFraser HeightsGeorge GreenawayGeorges VanierGoldstone ParkGreen TimbersGuildford Learning CentreGuildford ParkH.T. ThriftHall's PrairieHarold BishopHazelgroveHillcrestHjorth RoadHollyHylandJ.T. BrownJames ArdielJanice ChurchillJohnston HeightsKatzieKennedy TrailKirkbrideL.A. MathesonLatimer RoadLena ShawM.B. SanfordMaple GreenMartha Jane NorrisMary Jane ShannonMcLeod Road TraditionalMorganMountainview MontessoriNewtonNorth RidgeNorth SurreyNorth Surrey Learning CentreOld Yale RoadPacific HeightsPanorama ParkPort KellsPrince CharlesPrincess MargaretQueen ElizabethRay ShepherdRosemary HeightsRoyal HeightsSAIL (@Brookside)SAIL Surrey Academy of Innovative LearningSemiahmooSemiahmoo TrailSenator ReidSerpentine HeightsSouth MeridianSouth Surrey/ White Rock Learning CentreStrawberry HillSullivanSullivan HeightsSunnysideSurrey CentreSurrey TraditionalT.E. ScottTamanawisW.E. KinvigWalnut RoadWestermanWhite RockWilliam F. DavidsonWilliam WatsonWoodland ParkSD39 Location *Admiral Seymour ElementaryBayview Community ElementaryBritannia Community ElementaryBritannia Community SecondaryCaptain James Cook ElementaryCarnarvon Community ElementaryChamplain Heights AnnexChamplain Heights Community ElementaryCharles Dickens AnnexCharles Dickens ElementaryChief Maquinna ElementaryCollingwood Neighbourhood ElementaryCrosstown ElementaryDavid Livingstone ElementaryDavid Lloyd George ElementaryDavid Oppenheimer ElementaryDavid Thompson SecondaryDr A R Lord ElementaryDr Annie B Jamieson ElementaryDr George M Weir ElementaryDr H N MacCorkindale ElementaryDr R E McKechnie ElementaryEcole Jules Quesnel ElementaryEcole Laura Secord ElementaryEdith Cavell ElementaryElsie Roy ElementaryEmily Carr ElementaryEric Hamber SecondaryFalse Creek ElementaryFlorence Nightingale ElementaryG T Cunningham ElementaryGathering Place Education CentreGeneral Brock ElementaryGeneral Gordon ElementaryGeneral Wolfe ElementaryGladstone SecondaryGraham Bruce ElementaryGrandview ElementaryHastings Community ElementaryHenry Hudson ElementaryJ W Sexsmith ElementaryJohn Henderson ElementaryJohn Norquay ElementaryJohn Oliver SecondaryKerrisdale AnnexKerrisdale ElementaryKillarney SecondaryKing George SecondaryKitsilano SecondaryL'Ecole Bilingue ElementaryLord Beaconsfield ElementaryLord Byng SecondaryLord Kitchener ElementaryLord Nelson ElementaryLord Roberts AnnexLord Roberts ElementaryLord Selkirk AnnexLord Selkirk ElementaryLord Strathcona ElementaryLord Tennyson ElementaryMagee SecondaryMaple Grove ElementaryMount Pleasant ElementaryNootka Community ElementaryNorma Rose Point SchoolPierre Elliott Trudeau ElementaryPoint Grey SecondaryPrince of Wales SecondaryQueen Alexandra ElementaryQueen Elizabeth AnnexQueen Elizabeth ElementaryQueen Mary ElementaryQueen Victoria AnnexQuilchena ElementaryRenfrew Community ElementaryShaughnessy ElementarySimon Fraser ElementarySir Alexander Mackenzie ElementarySir Charles Kingsford-Smith ElementarySir Charles Tupper SecondarySir Guy Carleton Comm ElementarySir James Douglas AnnexSir James Douglas ElementarySir John Franklin ElementarySir Matthew Begbie ElementarySir Richard McBride AnnexSir Richard McBride ElementarySir Sandford Fleming ElementarySir Wilfred Grenfell ElementarySir Wilfrid Laurier ElementarySir William Osler ElementarySir William Van Horne ElementarySir Winston Churchill SecondarySouth Hill Education CentreSouthlands ElementaryTecumseh AnnexTecumseh ElementaryTempleton SecondaryThunderbird ElementaryTillicum Community AnnexTrafalgar ElementaryTyee ElementaryUniversity Hill ElementaryUniversity Hill SecondaryVancouver Learn Network ElementaryVancouver Learn Network SecondaryVancouver Technical SecondaryWalter Moberly ElementaryWaverley ElementaryWindermere Community SecondaryXpey' ElementarySD41 Location *AlphaArmstrongAubreyBrantfordBrentwood ParkBuckinghamBurnaby CentralBurnaby MountainBurnaby NorthBurnaby SouthByrne CreekCameronCapitol HillCariboo HillCascade HeightsChaffey-BurkeClintonConfederation ParkDouglas RoadEdmonds CommunityForest GroveGilmore CommunityGilpinGlenwoodInmanKitchenerLakeviewLochdale CommunityLyndhurstMaintenance ServicesMarlboroughMaywood CommunityMontecitoMorleyMoscropNelsonParkcrestRosserSeaforthSecond Street CommunitySouth SlopeSperlingStoney Creek CommunityStride Avenue CommunitySuncrestTaylor ParkTwelfth AvenueUniversity HighlandsWestridgeWindsorSD68 Location *Aurora Learning CentreBayview Elementary SchoolBrechin Elementary SchoolCedar Community Secondary SchoolCedar ElementaryChase River Elementary SchoolCilaire Elementary SchoolCinnabar Valley Elementary SchoolCoal Tyee Elementary SchoolContinuing Ed SD 68Departure Bay Elementary SchoolDover Bay Secondary SchoolFairview Elementary SchoolForest Park Elementary SchoolFrank J. Ney Elementary SchoolGabriola Elementary SchoolGeorgia Avenue Elementary SchoolHammond Bay Elementary SchoolIsland ConnectED (Learn@Home)John Barsby Community SchoolLadysmith Intermediate SchoolLadysmith Primary SchoolLadysmith Secondary SchoolMcGirr Elementary SchoolMountain View Elementary SchoolNanaimo Career & Technical CentreNanaimo District Secondary SchoolNorth Oyster Elementary SchoolNorthbrook Learning CentrePark Avenue Elementary SchoolPauline Haarer Elementary SchoolPleasant Valley Elementary SchoolQuarterway Elementary SchoolRanderson Ridge Elementary SchoolRock City Elementary SchoolSeaview Elementary SchoolUplands Park Elementary SchoolVast Centre SchoolWellington Secondary SchoolNextEmployee Name *FirstLastEmployee # *Position *Aboriginal Support WorkerAccountant Compliance/Int CtrlAccountingAccounts Payable TechnicianAccounts Receivable TechnicianAdmin AssistantAdministrative OfficerAdministrative Supp Ell/SwisApplications Analyst-Infor SysAssist.Dir-Grounds/Trans/CustAssistant Secretary-TreasurerAssistant SuperintendentAssistant Supt PolicyAssociated ProfessionalAsst/Dir/Phys.Plant Oper/MaintAutism Support WorkerBudget OfficerBus DriverBus MonitorBusiness Systems TechnicianBuyerCafeteria AssistantCareer AdvisorCareer Advisory AssistantCarpenterCasual Excluded StaffChief Financial OfficerChild Care WorkerClericalClerk StenoClerk Typist-LibraryComm And Events SpecialistCommunity School CoordinatorCo-Op StudentCoordinatorCo-Ordinator - Apex ProgramCoordinator-IspCrosswalk SupervisorCustodianCustodian ForemanDepartment HeadDeputy Superintendent Educ SvcDirectorDirector - FacilitiesDirector - IspDirector Human ResourcesDirector Of FinanceDirector Of InstructionDirector Of OperationsDirector-Energy & Environment|Director-Energy & EnvironmentDirector-Info Sys & Technology|Director-Info Sys & TechnologyDirector-Learning Support ServDispatcherDistrict Administrator/Level2District PrincipalDistrict Teacher AllowanceDistrict Vice PrincipalDrug & Alcohol Worker|Drug & Alcohol WorkerEAEduc Inter-Educ Asst For D&Hh|Educ Inter-Educ Asst For D&HhEduc Interpreter SupervisorEduc. Software System Coord.Educ.Interpreter/Ta Deaf & Hh|Educ.Interpreter/Ta Deaf & HhElectricianEnergy SpecialistEnterprise Software EngineerEnterprise Sys AdminEquipment OperatorExchangeExec Asst - SuperintendentExec Director- Lsd FoundationExec. Asst To Secretary TreasExecutive AssistantFamily Support WorkerForeman GroundsForeman Tc CarpenterForeman Tc ElectricianForeman Tc Hvac MechanicForeman Tc MechanicForeman Tc PainterForeman Tc Plumber GasfitterForeman Trades CertifiedGlazierGroundskeeperGroundskeeper GardnerGroup CoordinatorHealth & Safety Coordinator|Health & Safety CoordinatorHealth & Wellness Manager|Health & Wellness ManagerHomestay Coordinator - SummerHomestay Coordinator-IspHomestay OfficerHr Off-Health,Safety&Wellness|Hr Off-Health,Safety&WellnessHr OfficerHuman Resources CoordinatorInstructorInstructor - Non CertifiedIt Support TechnicianKitchen SupervisorLabourerLeadhand GroundsLeadhand Tc CarpenterLeadhand Tc ElectricianLeadhand Tc PainterLeave Of AbsenceLibrary AssistantLibrary Tech - SchoolsLibrary TechnicianLibrary/Info TechMail Services AssistantManagement Support OfficerManager - Technical ServicesManager, CommunicationsManager, Swis ProgramManager, Trans,GroundsManager-Accounting & Reporting|Manager-Accounting & ReportingManager-Building TradesManager-Energy,Envir.& Sp Proj|Manager-Energy,Envir.& Sp ProjManager-Facilities ServicesManager-Health & Safety|Manager-Health & SafetyManager-Health & Wellness|Manager-Health & WellnessManager-Human ResourcesManager-Maint/MechanicalManager-Pay/Benefits,PersonnelManager-Purchasing & Logistics|Manager-Purchasing & LogisticsMarketing CoordinatorMarketing Manager-IspMgr-Capital & Financial Plng|Mgr-Capital & Financial PlngMgr-Cust.Serv/Health & Safety|Mgr-Cust.Serv/Health & SafetyMgr-Planning & Financial Ctrl|Mgr-Planning & Financial CtrlNoon SupervisorOccupational TherapistOdyssey StudentOffice AssistantOffice Services SupervisorPainterPayrollPayroll SupervisorPayroll TechnicianPending -TeachPending-Excluded StaffPersonnel AssistantPhysiotherapistPlumberPrincipalPrint Services TechnicianPrint/Mail Services SupervisorProfessional Dev ClerkProfessional Serv AssistantProfessional Serv CoordinatorProfessional Serv SupervisorProgram Administrative Assist.Program Asst-Second LanguageProgrammerPsychologistPurchasingPurchasing AssistantPurchasing SupervisorReceiver WarehousemanReceptionistRecords Information OfficerRecreation Program LeaderRegistration OfficerResearch AssistantResource Center AssistantRoute DriverScience TechnicianSeaSec School Apprentice Prg AsstSecretary TreasurerSecretary-ElementarySecretary-TreasurerSenior Manager Human ResourcesSenior Systems EngineerService TechnicianSettlement WorkerSettlement Worker CoordinatorSpeech Language PathologistStrong Start FacilitatorStudent Helper/ShopperStudent Summer ApprenticeSummer Session TeacherSuperintendent Of SchoolsSupervisorSupervisor - TransportationSupervisor-Facilities ServicesT.A.-Spec.Ed./Physical NeedsTa-English As A Second LanguagTeacherTeacher AssistantTeacher On CallTech Support SpecialistTech Support Specialist Level2Technical Support SpecialistTechnicianTrades Cert CabinetmakerTrades Cert CarpenterTrades Cert Carpenter LocksmitTrades Cert Carpenter RooferTrades Cert ElectricianTrades Cert GlazierTrades Cert Hvac MechanicTrades Cert MechanicTrades Cert PainterTrades Cert Plumber GasfitterTrades CertifiedTrades Cert-Labour Mkt AdjTrades ForemanTrades LeadhandTransition CoordinatorUtility PersonVice PrincipalWarehousemanWork Experience StudentYouth Care WorkerOtherIncident Date / Time *DateTimeDetailed description of location of incident (ie: gym, soccer field, etc.) *Detailed description of the events leading up to the incident *What type(s) of behaviour did the student exhibit *PunchKickScratchBitePushPullGrabPinchVerbal threatSwearingThrowSpitOtherIf other, explain *Student Age *Student Initials *PEN #Does the student have a MoE designation? *YesNoIn progressIf other behaviour, explain *What might have contributed to this behaviour? *Anxiety/escape/avoidanceKnown or new trigger occurredAttention seekingTransition from activityResponse to request/actionEmbarassmentOtherCheck all that applyIf other cause, explain *Provide details of selection(s) above *How did you respond? *Redirected/DisengagedPhysically removed selfDe-escalated verballyBehaviour plan strategiesEmployee safety plan strategiesOtherCheck all that applyIf other response, explain *Provide details of selection(s) above *Select one following: *This incident requires corrective measures to be taken by Admin to minimize the risk of violence and/or injuryThis incident is not likely to lead to a risk of violence and/or injury, but should be communicated to the AdminAdministrator Email *EmailConfirm EmailEmailSubmit