Individual Incident Report (IIR) Form - School Safety and Educational Climate

Aug 30, 2026

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Individual Incident Report (IIR) Form用于学校在学年及夏季期间（7月1日至次年6月30日）上报所有暴力或扰乱性事件。表格要求学校按事件类别、偏见关联情况、涉及武器的数量与类型、事件地点与时间等维度收集信息，并记录受害者或目标与加害者的年龄、年级、人数。对学生及教职员工采取的处分或转介措施、纪律时长以及调查说明需在表中提供。报告以纸质或电子形式留存，避免向SED提交IIR副本。

LanguageEnglish

CategoryForms

FormatDOCX

Pages5

Reading Time2 min

AccessFree to download

Incident classification

Weapon and incident details

Persons involved and actions taken

Student and staff offender records

Investigation description and retention

Individual Incident Report (IIR) Form Education Law §2802 and the Commissioner’s regulation 100.2 (gg) require schools to report all violent or disruptive incidents that occur during the school year and summer months, between July 1 and June 30, including when summer school is in session. It is expected that schools collect the required information (below), electronically or in paper form, using a format such as the Individual Incident Report (IIR). The format should be the basis for the submission of the annual School Safety and the Educational Climate (SSEC)Summary Data Collection Form. Do not send copies of IIR forms to SED. Category of Incident (Check any that apply): Incident was biased related (Check any that apply): Incident was: (Check if applies) If the incident involved the use of one or more weapons, indicate the number of weapons, by weapon type used, listed below: Incident was: (Check any that apply) The location/time of the incident: (Check any that apply) Identify the grade and age if the target/victim was student (add more rows as needed): Indicate the number and types of targets/victims: (for any that apply) Indicate the number and types of offenders: (for any that apply) Report the age and grade of student offender(s) and indicate the duration (length of assignment) of discipline or referral action: (Check any that apply) Student Offender: Age____ Grade_____ (duplicate any necessary) Report the disciplinary or referral actions taken against staff or “other” offenders, such as being reported to law enforcement, etc. (duplicate if necessary) Report the number of students involved (as offenders) in incidents involving each of the following weapons at school: For the students who brought firearms to school reflected in row (e) above, report the disciplinary action imposed in rows (f) through (l) below. Provide a detailed description of the investigation that substantiates that the incident must be reported on the SSEC: Retain this form in the school. These reports are to be kept at the school until the youngest person involved in the incident is 27 years old (Do not send to SED)

FAQs

IIR表格需要上报哪些事件以及覆盖的时间范围？

表格要求学校上报学年及夏季期间发生的所有暴力或扰乱性事件，时间范围为7月1日至6月30日（含夏季学校在课期间）。

如果事件涉及武器，表格需要填写哪些信息？

需要注明武器使用的数量，并按武器类型填写；同时还需报告与不同武器相关的学生涉案人数（如适用）。

IIR表格需要如何保存，是否需要提交给SED？

学校需保留该表，直到参与事件中最年轻者满27岁为止，且不得向SED发送IIR表格副本。

Aug 30, 2026

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