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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
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Incident Report Form
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Incident Report Form

Complete all fields
Name (*)
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Address (*)
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City (*)
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State (*)
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Zip (*)
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Home Phone (*)
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Work Phone
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School Name (*)
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Grade Level (*)
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Subject Teaching (*)
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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?

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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
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Time of notice/incident
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Names of witnesses
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Location of incident
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Age of Child
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Sex of child
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Grade level of child
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Brief description of notice/incident in chronological order:
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