Student Safety & Behavior Concern Form

Student Safety & Behavior Concern Form

St. Vincent - St. Mary High School: Student Safety & Behavior Concern Report Form

Purpose of This Form

This form is used to report concerning behaviors, statements, bullying, harassment, or safety concerns involving a student or group of students. Reports are reviewed by the Student Support & Behavior Risk Assessment Team (SS-BRAT) using the CSTAG model. 

Our goal is to support students early, protect safety, and uphold the dignity of all members of the STVM community. 

Important: Please report what you observed or heard, not what you think it means. 

SECTION 1: Reporter Information

We strongly encourage you to provide your name and email address. This information will be kept confidential and will only be shared with members of STVM Senior Administration who are responsible for reviewing and responding to the concern. Providing your contact information allows us to follow up with you if additional information or clarification is needed. You may also submit this form anonymously. 

SECTION 2: Student(s) of Concern

Location and Context

(ex: 8:30 AM)

(Behavior-Based Description)
Please describe exactly what you observed or what was reported to you. Include specific words, actions, writings, posts, or behaviors if known.

SECTION 5: Type of Concern

SECTION 6: Bullying-Specific Information (If applicable)

(age, social status, group size, authority)

(check all that apply)

SECTION 7: Saftey Concerns (CSTAG Screening Support)

SECTION 9: Additional Information

SECTION 10: Acknowledgement

Thank you for bringing this concern forward. Reporting helps us:

  • Prevent harm
  • Care for the entire school community

All reports are reviewed promptly and handled with care and confidentiality.

St Vincent St Mary High School students in corridor in between classes, smiling, giving thumbs up.
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