Incident Report Incident Report Thank you for helping us to keep Delta safe. This report will be read by the principal, dean and counselors. This report is anonymous and we encourage you to share details about the incident that will help us with an investigation. OK Question Title * 1. What type of incident are you reporting? bullying/harassment/discrimination physical violence/assault/fight or threats of physical violence student in crisis/mental health drug use/abuse/distribution OK Question Title * 2. Have you reported this incident to anyone on campus? Yes No OK Question Title * 3. If yes, to whom? OK Question Title * 4. Please share the name or names of those who are involved in the incident OK Question Title * 5. Do you believe this person is being targeted based on their actual or perceived ancestry, age, color, disability, gender, gender identity, gender expression, nationality, race or ethnicity, religion, sex, sexual orientation, or association with a person or a group with one or more of these actual or perceived characteristics. Yes No OK Question Title * 6. Where did this incident occur? OK Question Title * 7. Please share what you know about this incident OK Question Title * 8. What was the impact of this incident on you? OK Question Title * 9. Would you like to be contacted regarding this incident? Yes No OK Question Title * 10. If yes, please provide your name and contact information below OK DONE