Youth Violence Prevention Council

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Shasta County Youth/Peer Court

SCHOOL INCIDENT REPORT

School: _____________________________________________________

Student Name: _______________________________________________

Log # from SRO: _____________________________________________

SRO Name: __________________________________________________

Narrative of Incident: (Date of occurrance,what happened, when and where incident occurred, who observed it, names and contact numbers of witnesses/victims). This does not need to be completed if a crime report was done.

_______________________________________________________________

________________________________________________________________________________________________________________________________________

Please Attach to Referral Face Page and school printouts.

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Shasta County Youth/Peer Court

Mail or Fax to: Shasta County Youth/Peer Court

1700 Pine St., Suite 250

Redding, CA 96001

Phone: (530) 244-7194 Fax: (530) 244-4150

Attn: Youth/Peer Court Coordinator