If you are reporting a Violent Incident involving yourself, please complete the following two forms:

Click here for a definition of workplace violence: (see attached document)

1.  The Employee Accident/Violent Incident Report – Form 421-1.

Click here to locate this form on the Board website.

Please Note: This form should be faxed or emailed to the Board office within 24 hours or as soon as possible.  Please do not allow the principal to keep the form.  The principal is to sign the form and may add comments if they so wish.  You may give them a copy of the signed form once it has been faxed or emailed.  The principal will need a copy to complete the supervisor investigation form 421-2.

2.  Violent Incident Reporting Form.  Please use the link below to complete this online form.

Click Here to Complete the Online Form

Violent Incident Report Form

If you are reporting an accident that occurred while at work, you only need to complete form 421-1 and follow the reporting process outlined on the Board’s webpage. As well as faxing this form to Human Resources Support Services, please fax a copy to the Local office. (Fax: 613-962-4618)

Click here for more information on workplace accident reporting (WSIB).

If this violent incident involves a pupil and the behaviour of the pupil can lead to a suspension, you MUST also complete form 378-15. Examples of such behaviour would be: uttering a threat, swearing at a teacher or at another person in a position of authority, bullying. See Safe Schools Incident Reporting below.

Safe Schools Incident Reporting:

If you have observed or become aware of a pupil “behaving in a way that is likely to have a negative impact on the school climate”, a response is now required of you.  The behaviour should be reported to the principal as soon as possible so that the principal can formulate a response.  You are asked to complete a copy of form 378-15 Student Safe Schools Incident Reporting Form – Part 1 on every occasion when a report is made to the principal regarding student misconduct which can lead to a suspension or expulsion.  Wherever possible, it is expected that the teacher will provide an oral report to the principal at the earliest, safe opportunity.  The written report (Form 378-15) must be submitted to the principal/vice-principal or teacher-in-charge when it is safe to do so and no later than the end of the school day.  Form 378-15 provides a list of activities for which suspension/expulsion must be considered.  A copy of this form should be kept in a Safe Schools Reporting Form Folder.(See below) For your own protection, ETFO is advising members that the acknowledgement of receipt of a report (Form 378-15A Student Safe Schools Reporting Form – Part 2) that you receive from the principal, when you meet to discuss the status of the investigation, is a crucial document and should be kept in this folder. 


378-15 Student Safe Schools Incident Reporting Form


Safe Schools Incident Reporting Form Folder

Your school should have pre-numbered copies of this form available to all staff.