School: __________________________________ Date: ____ / ____ / ____
Student's Name: _________________________________ Year Level: _______
Description of Incidents
First Inappropriate Behaviour: ________________________________________
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________________________________________________________________
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Management of Incident: ____________________________________________
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Witnessed by: __________________________
******
Second Inappropriate Behaviour: _____________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Management of Incident: ____________________________________________
________________________________________________________________
Witnessed by: __________________________
******
Third Inappropriate Behaviour: ________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Management of Incident: ____________________________________________
________________________________________________________________
________________________________________________________________
Witnessed by: __________________________
Signed:.................................., ..................................., Camp.Leader
.................................., ..................................., TEEC.Principal
.................................., ..................................., Parent /Guardian
(Name, Please print)