Sample for Incident Report

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					                                             School Safety and Discipline Reporting 2010-2011 School Year

The following is being provided as an option to assist districts in reporting School Safety and Discipline (SSDR) information for the 2010-2011 school year.
 An application is available to transmit the information via an on-line form. However, the Department can also accept text files or CSV files in place of a
district using the on-line form. Text Tab delimited files are not acceptable.


Process Overview:

1. Review file documentation.

2. File upload process:·

The file upload process is now included in the School Safety and Discipline Report application (SSDR). To upload a file log into the security portal and
click on School Safety and Discipline. Once there you will have the option to either enter your data through the on-line form or upload your data with the
new application.
If you have previously uploaded SSDR files to the Department you will only have the option to upload files. If you had previously used the on-line form and
would now like to upload a file please contact the Department to request the SSDR File Upload security role. We will grant the role to your organization
and you will then need to check with your Directory Administrator (DA) who will grant the role at the individual level (local staff members). If you have used
the File Upload in the past, your organization should already have the role but you will need to check with your Directory Administrator (DA) to confirm that
you are listed with the SSDR File Upload security role or if you need to be assigned the role.
Once you upload a file the data will be automatically validated and an edit report will be generated immediately.
For your convenience both options are available through out the year.

3. File specifications:
Please submit two separate files (Text or CSV files), one for the incident and another for the discipline records as indicated in the instructions. Partial files
can be transmitted during the year to be validated and corrected as needed. At the end of the school year the final files should include all the incident and
discipline records that occur between July 2, 2010 through the last day of school, June 2011. This is due by July 29, 2011.

4. Corrected files are uploaded and processed at the Department.

5. Once files are clean, you will receive a success message.

Detailed information regarding how to report an incident or discipline record can be found on our website at:
http://www.doe.mass.edu/infoservices/data/guides/ssdr.doc
If you have any questions or require additional information please contact Dianne Russell at 781-338-6824 or drussell@doe.mass.edu.
INCIDENT REPORT
       Column
Column Heading    Field Name                   Field Format  Field Description
A      INC ID     Incident ID                  Unique Number District Defined Incident ID (eg 1,2,3) Must be unique for each incident.
                                               Date:
B      INC DATE   Incident Date                mm/dd/yyyy    Date Incident Occurred
C      SCH NAME   School Name                  Text          Name of the school reporting the incident.
D      SCH CODE   School Code                  Alphanumeric  8 digit school Code
                                                             Is this a violence or drug related incident?Y or N, Please see Table 1 below for the list of
                                                             offense types.(If this is not a violence or drug related incident please respond by entering
                                                             "N" in this Column, enter incident ID, incident date, school name and code, use 500 in
                                                             columns G - K indicating "Does not apply" and other fields should either be: text field equal
E      INC IND    Incident Indicator           Text          blank, numeric field equal zero, on the incident report.
                                                             Did this incident result in a disciplinary action?Y or N (If the incident resulted in any
                                                             disciplinary action listed in table 3 (next page), please enter "Y" in this column and report
                                                             all the data related to each offender disciplined, in the discipline report. If the incident did
                                                             not result in any disciplinary action listed in table 3 (next page), please enter "N" in this
F      DISC IND   Discipline Indicator         Text          column, No entry is needed for this incident on the discipline report.
G      OT1        Type Of Offense ID 1         Text          (See Offense Type Codes below) - Table1
                                                                (See Offense Type Codes below) - Table1.      If additional offenses do not apply to this
H      OT2        Type Of Offense ID 2         Text             incident default value is 500.
                                                                (See Offense Type Codes below) - Table1.      If additional offenses do not apply to this
I      OT3        Type Of Offense ID 3         Text             incident default value is 500.
                                                                (See Offense Type Codes below) - Table1.      If additional offenses do not apply to this
J      OT4        Type Of Offense ID 4         Text             incident default value is 500.
                                                                (See Offense Type Codes below) - Table1.      If additional offenses do not apply to this
K      OT5        Type Of Offense ID 5         Text             incident default value is 500
L      VS         Number Of Victims:Students   Number(3)
                  Number Of Victims:School
M      VSCHP      Personnel                    Number(3)
                  Number Of Victims:Non-Sch
N      VNSCHP     Personnel                    Number(3)
O      VU         Number Of Victims:Unknown    Number(3)
                  Number Of
P      OFFES      Offenders:Students           Number(3)
                  Number Of Offenders:Non-
Q      OFFENS     Students                     Number(3)
                  Number Of
R      OFFEU      Offenders:Unknown            Number(3)
                  Additional description for                    Enter other text, if needed. The only valid Characters this field can contain are spaces.
S      INC DESC   incident types               Text
                                                                Did this incident result in a physical injury? Y, N for offense type 2, 4, 6, 9, 12, 15
T      PHYS INJ   Physical Injury              Text             or 16 or X for not applicable (all other offense types).
                  TABLE1

  Offense
Type Codes -                     OT_DESC
 Column G -
      K
      1a       Tobacco use (cigarettes, cigars, pipes or
      1b       Alcohol possession
      1c       Alcohol use
      1d       Marijuana possession
      1e       Marijuana use
      1f       Possession of other illegal substances
      1g       Illegal use of other substances
      1h       Sale of illegal drugs
      1i       Possession of illegal drugs with intent to sell
       2       Physical fight
       3       Threat of physical attack
       4       Physical attack, assault (non-sexual)
       5       Sexual Harassment
       6       Sexual assault (including rape)
       7       Theft (school, staff or student property)
       8       Threat of robbery
       9       Robbery using force
      10       Vandalism/Destruction of Property
      11       Destruction of Property due to arson
      12       Kidnapping
      13       Homicide
     14a       Knife (cutting weapon)
     14b       Gun
    14b1       Handgun
    14b2       Rifle
    14b3       Shotgun
    14b4       Other Fire Arm
     14c       Explosive or incendiary device
     14d       Other Weapon
      15       Other violence, drug or criminal incident
      16       Felony Conviction Outside of School
    500        Does not apply. Not a violence or drug related
                                                      DISCIPLINE REPORT (STUDENT DATA)
       Column
Column Heading        Field Name                   Field Format

A      INC ID         Incident ID                  Number
                                                   Date:
B      INC DATE       Incident Date                mm/dd/yyyy

C      SASID          Student SASID                Text(10)
D      FN             First Name                   Text
E      LN             Last Name                    Text
                                                   Date:
F      DOB            Date of Birth                mm/dd/yyyy
G      PST            Program Status Code
                      Disciplinary action taken    Text
H      DAT            code                         Text



I      BI INC         Bodily Injury Incident       Text
                      Start Date of disciplinary   Date:
J      SD             action                       mm/dd/yyyy
                      Date Student Returned        Date:
K      RD             to school                    mm/dd/yyyy
                      Date Student Eligible to     Date:
L      ERD            Return to school             mm/dd/yyyy
                      Number of School Days
M      DM             Missed                       Number(3)

                      Alternative Education
N      AEINC          Indicator                 Text
                      Alternative Education
O      AE             provided_ Code            Text
                      Alternative Education not
P      NAE            provided_Code             Text


                                                                         TABLE 2
        Program
         Status
                                                                               PST_DESC
         Codes-
        Column G
            1         General Education
            2         Special Education - student has an Individualized Educational Plan

                                                                         TABLE 3
       Disciplinary
          Action
          Taken                                                                DAT_DESC
         Codes-
        Column H
                 1        In-school suspension (1 day or more)
                 2        Out of school suspension (1 day or more)
                 3        Expulsion *
                 4        Removed by an impartial hearing officer to an alternative setting
                          Removed by school personnel to an alternative setting (Items 4 and 5 are only applicable for Program
                 5        Education)

            Table 3A--
            Start and
                                                                                       SD, RD & ERD
             Return
              Dates
                1         Indicate date student was initially removed from school in this instance. Date must be during 2010-11
                          Complete only ONE of the two following items, leave other blank.
                 2        Indicate date if the student returned to school.
                          If the student has not yet returned to school and is eligible to return, indicate date eligible to return. En
                 3        was removed for remainder of the 2010-11 school year.

                                   TABLE 4
             Alt Ed
             Codes-                       AE_DESC
            Column O
                1         Home Tutoring
                2         In-district alternative program
                3         Alternative program in another district
                4         Private alternative setting
                5         Work/community service setting

                                   TABLE 5
            No Alt Ed
             Codes-                      NAE_DESC
            Column P
                1         Moved / transferred
                2         Refused / did not respond
                3         Incarcerated*
                          School exercised its right to not provide
                 4        alternative education*

* Students who are incarcerated may be expelled. Students with disabilities may be expelled, or removed from the current setting permanen
  DISCIPLINE REPORT (STUDENT DATA)


             Field Description
             Corresponding Incident ID created on Incident report.

             Date Incident Occurred. This should be the same date as the one created on incident
             report.
             State Assigned Student ID, one for each student (If a student is disciplined more than
             once the SASID should be reported again with a different incident ID.)




             See Table 2 - Program Status Codes
             See Table 3 - Disciplinary Action Taken Codes
             Is this student being disciplined as the result of an incident that caused serious bodily
             injury? Answers: Y or N. This field is only applicable to SPED students that are
             removed from their educational setting by a hearing officer. If the student being
             disciplined is a general education student, please leave blank.

             See Table 3A--Start and Return Dates

             See Table 3A--Start and Return Dates

             See Table 3A--Start and Return Dates
             Total number of days where student was not in his or her original educational setting.

             Is the student being (or has been) provided an alternative education?Y or N. If "Y",
             use appropriate code from table 4 in column O. If "N", use appropriate code from table
             5 in column P.
             See Table 4 - Alt Ed Codes (If Alternative Ed is not provided leave blank).

             See Table 5 - No Alt Ed Codes (If Alternative Ed is provided leave blank).



                        TABLE 2


                              PST_DESC



has an Individualized Educational Plan

                        TABLE 3


                              DAT_DESC
or more)
day or more)

aring officer to an alternative setting
el to an alternative setting (Items 4 and 5 are only applicable for Program Status = 2. Special




                               SD, RD & ERD


tially removed from school in this instance. Date must be during 2010-11 school year.
 two following items, leave other blank.
eturned to school.
urned to school and is eligible to return, indicate date eligible to return. Enter 09/01/11 if student
of the 2010-11 school year.




s with disabilities may be expelled, or removed from the current setting permanently for disciplinary reasons.
This page explains the Incident file layout, including the file header and the order in which the columns should be displayed, followed by a sample file below.
Please keep in mind that you can only submit Text files or CSV files. Text Tab delimited files are not acceptable.



INCIDENT REPORT

Header
INC ID, INC DATE,SCH NAME,SCH CODE,INC IND,DISC IND,OT1,OT2,OT3,OT4,OT5,VS,VSCHP,VNSCHP,VU,OFFES,OFFENS,OFFEU,INC DESC,PHYS INJ


Layout

INC ID       INC DATE   SCH NAME   SCH CODE      INC IND   DISC IND     OT1       OT2 OT3           OT4         OT5          VS       VSCHP VNSCHP VU       OFFES OFFENSOFFEU INC DESC PHYS INJ

         1    11/15/2008 schoolA       19999999 Y          Y                  4    500        500         500          500        1       0      0      0       2     0     0          Y

         2    10/12/2008 schoolB       29999999 N          Y              500      500        500         500          500        0       0      0      0       0     0     0          X



         3    10/30/2008 schoolC       39999999 Y          N                  7    500        500         500          500        0       0      0      0       1     0     0          X

                                   `
Sample

INC ID, INC DATE,SCH NAME,SCH CODE,INC IND,DISC IND,OT1,OT2,OT3,OT4,OT5,VS,VSCHP,VNSCHP,VU,OFFES,OFFENS,OFFEU,INC DESC,PHYS INJ
1,11/15/2008,schoolA,19999999,Y,Y,4,500,500,500,500,1,0,0,0,2,0,0,Y
2,10/12/2008,schoolB,29999999,N,Y,500,500,500,500,500,0,0,0,0,0,0,0,X
3,10/30/2008,schoolC,39999999,Y,N,7,500,500,500,500,0,0,0,0,1,0,0,X


Comments:
* Incident ID appears in both files. Incident and Discipline.
* Incident ID is unique in the Incident report
* Incident ID is repeating in the Discipline report based on how many student offenders are being disciplined for each incident.
   i.e. Incident ID 1 appears twice on the Discipline report because there are 2 student offenders being reported for this incident in the Incident report.
* Incident Indicator and Discipline indicator are key fields that help you determine what data to report in both files (see different Examples above).
This page explains the Discipline file layout, including the file header and the order in which the columns should be displayed, followed by a sample file below.
Please keep in mind that you can only submit Text files or CSV files. Text Tab delimited files are not acceptable.


DISCIPLINE REPORT

Header
INC ID,INC DATE,SASID,FN,LN,DOB,PST,DAT,BI INC,SD,RD,ERD,DM,AEINC,AE,NAE


Layout

INC ID       INC DATE    SASID          FN          LN          DOB         PST            DAT       BI INC       SD         RD          ERD
         1     11/15/2008 1111111111    Chris       Smith        01/01/1989            1           2               11/16/2008 11/20/2008
         1     11/15/2008 2222222222    Sue         Jones        01/02/1989            2           2 Y             11/16/2008 11/20/2008
         2     10/12/2008 3333333333    Sam         Deer         05/12/1990            2           1 N             10/13/2008 10/15/2008



Sample

INC ID,INC DATE,SASID,FN,LN,DOB,PST,DAT,BI INC,SD,RD,ERD,DM,AEINC,AE,NAE
1,11/15/2008,1111111111,Chris,Smith,01/01/1989,1,2,,11/16/2008,11/20/2008,,4,N,,4
1,11/15/2008,2222222222,Sue,Jones,01/02/1989,2,2,Y,11/16/2008,11/20/2008,,4,Y,1
2,10/12/2008,3333333333,Sam,Deer,05/12/1990,2,1,N,10/13/2008,10/15/2008,,2,N,,2


Comments:
* Incident ID appears in both files. Incident and Discipline.
* Incident ID is unique in the Incident report
* Incident ID is repeating in the Discipline report based on how many student offenders are being disciplined for each incident.
   i.e. Incident ID 1 appears twice on the Discipline report because there are 2 student offenders being reported for this incident in the Incident report.
* Incident Indicator and Discipline indicator are key fields that help you determine what data to report in both files (see different Examples above).
d by a sample file below.




              DM         AEINC   AE       NAE
                       4 N                      4
                       4 Y            1
                       2 N                      2




 Incident report.
ples above).
Violence and Drug Related Incident Forms

Incident Date: required, acceptable values = 07/02/2010 – 06/29/2011
Table1
                            If illegal substance (1a through 1i) selected, must have at least one offender
1
1a                          Victims can not be reported for lines 1a through 1i
                            If 1f or 1g (other substance) is selected then must have at least one offender
                            and a description in the text box. Also, if description entered, then item 1f or 1g
1b                          must be selected
2                           If physical fight selected must have at least 2 offenders
                            Note: Victims can not be reported for question 2
                            If threat of physical attack selected must have at least one victim and one
3                           offender
4                           If physical attack selected must have at least one victim and one offender
                            If sexual harassment selected must have at least one victim and one offender
5
6                           If sexual assault selected must have at least one victim and one offender
                            If theft of school, staff or student property selected must have at least one
7                           offender
8                           If threat of robbery selected must have at least one victim and one offender
9                           If robbery by force selected must have at least one victim and one offender
                            If vandalism/destruction of property selected must have at least one offender
10
                            If destruction of school property due to arson selected must have at least one
11                          offender
12                          If kidnapping selected must have at least one victim and one offender
13                          If homicide selected must have at least one victim and one offender
                            If weapon on school premises selected must have at least one offender (14a
14                          through 14d)
                            If 14b4 other firearm or 14d other weapon selected must have at least one
                            offender and description in text box. Also, if description entered, then item
14a                         14b4 or 14d must be selected
                            If other violence or substance-related incident selected must have at least one
                            offender and description in text box. If description entered, then other violence
15                          or substance-related incident must be selected.
                            If felony outside of school selected, must have at least one offender and
                            description in text box. If description entered, then felony outside of school
16                          must be selected.

Discipline Form
Columns:
B                            Incident Date: required, acceptable values =07/02/2010 – 06/29/2011
                             Incident ID: District Defined Incident ID (e.g. 1,2,3) Must be unique for each
A                            incident.

C                            SASID required to create student discipline record, valid SASID within district
H                            Disciplinary Action:         # of days
                             1. In-school suspension           1-10
                             2. Out of School suspension      1-200
                             3. Permanent Expulsion          1-200
    Is this student being disciplined as a result of an incident that caused bodily
    injury? This field is only applicable to SPED students that are removed from
I   their educational setting by a hearing officer.
    Start Date: must be equal to or after the incident date, acceptable values =
J   07/02/2010 – 06/29/2011
    Date Returned: - acceptable values = 07/02/2010 – 06/29/2011, must be prior
K   to date data is being entered. If expulsion, then leave blank.
    Date Eligible to Return: acceptable values = 07/02/2010 – 06/29/2011 If
L   expulsion, then leave blank.
M   Number of School days missed:
    Can not be 0
    Will be validated against disciplinary action (see above)
N   Alternative Education
    If Yes, complete column O and leave column P blank.
    If No, complete column P and leave column O blank.
                                                 Incident Occurs


                                                   Is it Drug or
                                                 Violence Related?
                       YES                                                                    NO



                                 General Education Student
     Student Offender not
                               offender or Student offender on
          receiving a
                                  an Active IEP receiving a          Sped student offender         Gen Ed student receiving
     disciplinary removal      disciplinary removal for one or       receiving a                   a disciplinary removal for
                                          more days                  disciplinary removal              more than 10 days
                                                                     for one or more days


                    Incident
NO                   Report    Discipline       Incident
Discipline          Required   Report for       report                                                            No Incident
data to                                                               No Incident            Discipline           data to report
                       (1)     each             Required (1)          data to report         report for each
report but                     student                                                                            but log the
log the                                                               but log the            student              incident ID,
                               Offender                               incident ID,           offender
incident ID                                                                                                       inc date, sch
and incident                   required              Discipline       inc date, sch          required             name, sch
date in the                                          report for       name, sch                                   code, inc ind
Discipline                                           each student     code, inc ind                               and disc ind in
report.                                              offender         and disc ind in                             the incident
                                                     required         the incident                                report
                                                                      report

				
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Description: Sample for Incident Report document sample