School Safety Dispatch Checklist Form
Complete this checklist to report and coordinate a school safety incident or concern. Ensure all details are accurate for effective response.
Incident Reference Number
*
Date and Time of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Incident Location (Building/Area)
*
Type of Incident
*
Please Select
Medical Emergency
Fire/Smoke
Intruder/Security Threat
Environmental Hazard
Suspicious Activity
Fight/Disruption
Other
Severity Level
*
Low (Minor, no immediate danger)
Moderate (Needs attention, not critical)
High (Immediate threat or injury)
Immediate Actions Taken
*
Notified School Administration
Contacted Emergency Services
Evacuated Area
Provided First Aid
Secured Scene
Other
People Involved (Names and Roles)
*
Dispatch Request Details
*
Follow-up Status
*
Please Select
Open - Awaiting Action
In Progress
Closed - Resolved
Closed - Unresolved
Additional Comments or Notes
Submit Checklist
Should be Empty: