THREAT ASSESSMENT REPORT
Put a description of the form or when it should be used here (Calibri 11pt Italics).
Student Information
Last Name
First Name
Student ID Number
Grade Level
Homeroom Teacher
Step 1: Determine if Credible Threat
Administrator completing report
Date of incident
Person who first reported incident
Time of first report
Reported by: (Check all that apply)
☐ Student ☐ Teacher ☐ Support Staff ☐ Guidance Counselor ☐ Parent
Nature of threat or specific threat (exact words if possible, or if a written threat, attach a copy)
Parent/Guardian notified on
Notification time
Notification made by
Findings
What the threat determined to be credible
☐ Unfounded
Notes / Recommended action
☐ Founded
Person responsible
Threat Assessment Report
Due Date
Developed by: Charter Support Unit
Step 2: Inquiry Initiated (Only if the threat was founded in step 1)
Threat Assessment Team Members
Notified On
Was the district notified?
When / Notes
Notification Time
☐ Yes ☐ No
Were the parents notified
If yes, when? If no, why?
☐ Yes ☐ No
Inquiry meeting held on (date)
Meeting time
Meeting facilitator
Findings
What the threat determined to be credible
☐ Unfounded
Notes / Recommended action
☐ Founded
Person responsible
Threat Assessment Report
Due Date
Developed by: Charter Support Unit
Step 3: Investigation
Following the investigation was law enforcement notified
☐ Law enforcement notified
Law enforcement officer’s name
☐ Law enforcement not notified
Date of notification
Time of notification
Did the law law enforcement officer follow up with charges
☐ Criminal charges were filed
☐ No criminal charges made
Type of charges filed
Criminal report number
Additional Follow Up Notes
Notes / Recommended action
Person responsible
Due Date
Signatures of all threat assessment team members
Print name, title
Signature
Threat Assessment Report
Date
Developed by: Charter Support Unit