The survey is for the AMOT Local to monitor the implementation of PPM 144/45 (Ministry of Education's Policy/Program Memorandum - Safe Schools). Please complete this survey each and every time you complete a Safe Schools Form.  An AMOT Released Officer may contact you as a follow up.

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* 1. Date of Incident

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* 2. Last name, First name:

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* 3. School:

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* 4. Email address:

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* 5. Phone # where you can be reached most easily (please note if home/office/cell)

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* 6. Initials of Student:

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* 7. SUSPENSION: Please indicate the activity(s) committed: Activities for which suspension must be considered under subsection 306(1) of the Education Act

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* 8. Expulsion: please indicate the activity(s) committed: Activities for which expulsion must be considered under subsection 310(1) of the Education Act

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* 9. Please indicate the following which have occurred:

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* 10. Please add comments if you so desire:

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* 11. Were you injured, or did you have the potential of being injured during the incident that prompted the completion of the Safe Schools form?

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* 12. Do you feel unsafe in this particular classroom or school?

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* 13. If you answered Yes to question 11, have you completed an Employee Accident and Incident Report, submitted it to the administrator and emailed a copy (screen shot) to the AMOT office at etfokimfin@gmail.com?

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