Notification of Assault

The SEA recommends you fill out a “Notification of Assault” report whenever you feel you have been a victim of an assault, regardless of physical injury or intent.

CEA Legal defines assault as “any unwanted physical contact.”

This report needs to be filled out as soon as possible following an incident of assault. Once submitted a copy will automatically be sent to your building principal and a redacted copy will be sent to SEA Leadership and the Superintendent.

This form does not take the place of the report submitted by the school Nurse regarding any injuries that may have occurred during an assault for the purposes of Workman’s Compensation claims and should be filed in conjunction should an injury occur.

Email of Person Submitting This Form

example@example.com

Please select the school(s) where administration should be notified.

Employee Name

First NameLast Name

Date and Time of Assault

Date

Hour MinutesAM/PM Option

Location of Assault

Student Involved

Brief Description - Please do not include student names in this section.

This report is being provided in compliance with Connecticut General Statute Section 10-233g[a] and the Agreement between the Stratford BOE and SEA Article XIV Sections A & B.