Employee Internal Investigation Report - Excel

Document Sample
Employee Internal Investigation Report - Excel Powered By Docstoc
					                  Georgia Professional Standards Commission (GaPSC)
                            Report of State Student Assessment Violation
Educator's Name:
Educator's Cert/PSC ID #:
Educator's Home Address:
Educator's Home Phone #:
Educator's Cell Phone #:
Educator's Position:
School Name:
School Address:
Principal:
School Test Coordinator:
Phone #:
System Name:
System Address:
Superintendent:
Phone #:
System Test Coordinator:
Phone #:
Name of Test:
Form # or Test ID #:
Name of Test Section/Subject:
Grade Level of Test:                                     (List Grade if grade specific OR Elem, MS or HS)
Date(s) of Administration:
Dates(s) of Violation(s):
Was an IEP involved?
Was an IAP involved?
Was a TCP involved?
Number of Students Impacted:
Were their scores invalidated?
Were their scores marked Test Irregularity?
Date Reported to GDOE:
GDOE Instructions To System:
Were DOE instructions followed?
Was a special administration of the test required?
Were parents of impacted student(s) notified?
Describe the unethical behavior of the educator:




     Person Submitting Report:
                      Position:
              Mailing Address:
Signature:                                                                             Date:
                                Georgia Professional Standards Commission
                                       State Student Assessment Violation Checklist
                                            Place a check beside all indicators violated.
                                          Superintendent and System Test Coordinator
Failed to develop and implement local policies and procedures based on Georgia Department of Education
guidelines and test publisher’s directions to maintain test security.
Failed to supervise and monitor Principals to ensure that they fulfill their specific roles and responsibilities for the
administration of tests.
Failed to ensure that all personnel involved with testing received training on appropriate test administration,
policies, and procedures including accommodations for each assessment given.
Failed to inform the Georgia Department of Education and Professional Standards Commission of a breach of
security or unethical behavior by an employee of the system.
                                             Principal and School Test Coordinator
Failed to ensure test security within the school building.
Failed to ensure distribution of test materials occurred immediately prior to test administration.
Failed to supervise all testing activities.
Failed to ensure that all school personnel had been appropriately trained on test administration, procedures, and
polices, including accommodations for each assessment given.
Failed to implement the system and school testing policies and procedures to ensure all students were tested fairly
and appropriately.
Failed to report immediately a breach of security or unethical behavior related to student assessment.

                                     All Staff Members Including Those Above
                                                     Before the Test Session
Revealed all or any part of copyrighted tests to students or others prior to test administration without direction by
the DOE.
Used test items and prompts prior to administration for instructional purposes.
Discouraged students from putting forth optimal effort based on the purpose of the test.
Reviewed or provided answers to test questions.
Possessed unauthorized copy(ies) of state tests.
Reclassified students solely for the purpose of avoiding or modifying state test administration..
                                                     During the Test Session
Varied from the directions outlined in the administration manual (i.e. time, reading verbatim, etc.)
Read parts of the test to students where it was not indicated in the directions (unless indicated by an IEP, IAP, or
TPC).
Failed to provide state approved accommodations as prescribed in a student’s IEP, IAP, or TPC plan.
Provided accommodations that were not included in the IEP, IAP, or TPC plan.
Interpreted, explained, or paraphrased the test items.
Defined or pronounced words used in the test.
Coached students during the test, including remarks about quality or quantity of student work.
Provided answers to test questions.
Revealed all or part of copyrighted tests to students or others prior to test administration without direction by the
DOE.
Used test items and prompts prior to administration for instructional purposes.
Failed to provide an appropriate testing environment (e.g. instructional materials removed/covered).
                                                      After the Test Session
Made inaccurate reports, unsubstantiated claims, inappropriate interpretations, or otherwise false and misleading
statements about assessment.
Discussed test items or answers.
Erased or changed student answers.
                                           At Any Time During Test Administration
Failed to account for all secure test materials as provided by the school test coordinator.
Compromised the integrity of the assessment.
Failed to report possible ethical violations by any professional.
                             Required Information: School System Investigation

Prior to submitting a report to the GaPSC, a school system should conduct an internal
investigation to determine what occurred pertaining to the alleged testing violation. The
complainant school system should include a copy of the school system’s investigative report with
the GaPSC report form.
At a minimum, a school system investigation report should answer the following questions:
 Who was involved?
 What happened?
 When did it happen?
 Where did it happen?
 Why did it happen?
 How did it happen?
A school system investigation report should include signed statements from the following:
System Test Coordinator - training provided and any investigation this individual conducted
School Test Coordinator - training provided and any investigation this individual conducted
Principal - training provided and any investigation this individual conducted
Students - what did each student witness that is germane to the issue
Test Examiner - what did he/she witness that is germane to the issue
Test Proctor - what did he/she witness that is germane to the issue
Any other witness - what did he/she witness that is germane to the issue
Witness statement forms are included in this package for providing this information.

A school system investigation report should reference all known items of physical evidence, and
copies of the evidence should be included with the school system’s report to the GaPSC.
Examples of physical evidence include, but are not limited to :
    Test questions/answers (Contact the Testing Director at DOE for procedures involving secure test items and information.)
    Altered or suspect answer documents (Contact the Testing Director at DOE for appropriate procedures.)
    Notes made about test content
    Cheat sheets
    Sign-in sheets for School Test Coordinator training.
    Syllabus/Agenda/Training Materials for School Test Coordinator training
    Sign-in sheets for Test Examiner/Test Proctor training
    Syllabus/Agenda/Training Materials for Test Examiner/Test Proctor training
    Test Security Sign-in/Sign-Out Sheets
    Signed Test Security Personal Affirmations or Agreements (signed by accused educator)
    Anything that demonstrates a violation of test procedures/administration or test security protocols
                         Required Witness Contact Information

Witnesses are critical elements in both the investigation and adjudication of an
Ethics matter. At a minimum, a complainant school system should include a list
containing the following witness contact information:

1. Student Witness Information:
  Name
  Grade Level
  Home Mailing Address
  Home Telephone Number
  Name of Parent/Guardian
  Parent/Guardian Alternate Telephone Numbers
  Parent/Guardian Alternate Addresses
  What this witness has knowledge of.

2. Certified Staff Witness Information:
  Name
  Position with the school system
  Work Mailing Address
  Work Telephone Number
  Home Mailing Address
  Home Telephone Number
  What this witness has knowledge of.

3. Other Witnesses Information:
  Name
  Association with the school system
  Work Mailing Address
  Work Telephone Number
  Home Mailing Address
  Home Telephone Number
  Other Telephone Numbers
  What this witness has knowledge of.
                                    Student Witness Statement Form

Student's Full Name:
Home Mailing Address:
Home Telephone Number:
Name of Parent/Guardian:
Parent/Guardian Relationship to Student:
Parent/Guardian Alternate Telephone #:
Parent/Guardian Alternate Addresses:
Please answer the questions below.
Who was involved?




What happened? (Use the back of the sheet if you need additional space.)




When did it happen?             Where did it happen?




           Signature                                                       Date
                               Certified Staff Witness Statement Form

Name:
Position with the school system:
Work Mailing Address:
Work Telephone Number:
Home Mailing Address:
Home Telephone Number:
Please answer the questions below.
Who was involved?




What happened? (Use the back of the sheet if you need additional space.)




When did it happen?                                 Where did it happen?




            Signature                                                      Date
                                     Other Witness Statement Form

Name:
Association with the school system:
Work Mailing Address:
Work Telephone Number:
Home Mailing Address:
Home Telephone Number:
Please answer the questions below.
Who was involved?




What happened? (Use the back of the sheet if you need additional space.)




When did it happen?                          Where did it happen?




            Signature                                                      Date

				
DOCUMENT INFO
Description: Employee Internal Investigation Report document sample