SUMMARY OF VIOLENT AND DISRUPTIVE INCIDENTS

July 1, 2004 through June 30, 2005

School Name: _______________________

BEDS Code: ________________________

This paper form must only be used for the local gathering of data.  Data represented in this form are required to be submitted to SED via the On-line BEDS IMF Application.  Your district's BEDS Coordinator or Superintendent will have details and protocol for entering data.

 

Do Not Send This Paper Form To SED
 
Each incident must be reported in only one category.  If the incident involves more than one category, report it in the category with the lowest number.  For example, if an incident involves a robbery (Category 3) and an assault with physical injury (Category 7), report the incident in Category 3.  Category definitions are summarized in this document and detailed in the Glossary of Terms.  Incidents in categories 1 through 8 must be reported regardless of whether or not the offender was disciplined or referred to law enforcement. Incidents in Categories 9 –20 should be reported if the consequences result in a disciplinary or referral action listed in columns j-o.  When the offender is not known, such as in a bomb threat or false alarm, the incident still must be reported.  Reports of alleged incidents of intimidation, harassment, menacing, or bullying that did not result in a disciplinary action must be reported in Item 2.  For additional information refer to the Q&A at http://www.emsc.nysed.gov/irts/violence-data/home.shtml.  Schools reporting no incidents must report zero (0) in Categories 1-20 Column (a), Item 2, and Item 6, questions must be answered in Item 7 and Item 8, and the Superintendent Certification must be completed.

1.      Violent and Disruptive Incidents

Incident Category

Number of Incidents

(a)

Number of Offenders

Number of Victims

Number of Incidents

How many enrolled student offenders were assigned or referred to:

(Report all consequences)

 

Counseling or Treatment Programs (j)

 

Teacher Removal

(Section 3214)

 

(k)

 

Suspension

From Class or Activities

(l)

Out-of-School Suspension

(m)

Transfer to Alternative Ed Program

(n)

Law Enforce-ment or Juvenile Justice

(o)

 

Involving Alcohol or Drugs

(h)

On School Transpor-tation

(i)

Students

(b)

Staff

(c)

Other

(d)

Students

(e)

Staff

(f)

Other

(g)

Incidents Involving Physical Injury or the Threat of Injury.

 

1.  Homicide: conduct that results in the death of another person.

 

With weapon(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Without weapon(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.1 Forcible Sexual Offenses: involving forcible compulsion.

 

With weapon(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Without weapon(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.2 Other sexual offenses: involving inappropriate sexual contact (no forcible compulsion.)

With weapon(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Without weapon(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. Robbery: forcible stealing of property from a person by threatening the immediate use of physical force.

 

 

 

 

 

 

With weapon(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Without weapon(s) 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Assault with Serious Physical Injury: intentionally or recklessly causing physical injury which creates substantial risk of death or serious disfigurement or impairment of health loss or impairment of the function of any bodily organ.

 

With weapon(s)