402.03E2 Abuse of Students by School District Employees Investigation

402.03E2 Abuse of Students by School District Employees Investigation

Student's name:                                                                

 

Student's age: _______     Student's grade: _______

 

Student's address:                                                             

 

Student's school:                                                              

 

Name of accused school employee                         Building               

 

Name and address of person filing report:                                                                                                                    

 

Name and address of student's parent or guardian, if different from person filing report:

                                                                                                                                                              

 

Date report of abuse was filed: ______  physical  ______ sexual*

 

Describe the nature, extent and cause of the student's injury, if any and if known:  (Attach additional pages if needed).

                                                                                                                                                                                 

                                                                                                                                                                                 

                                                                                                                                                                                 

                                                                                                                                                                                 

                                                                                                                                                                                 

 

Describe your investigation:  Attach additional pages if needed.  (Please do not use student witnesses' full names.)

                                                                                                                                                                                 

                                                                                                                                                                                 

                                                                                                                                                                                 

 

*Were parent(s) or guardian(s) advised of their right to see and hear any interview of their pre-kindergarten through sixth grade children who are alleged victims of or a witness in a sexual abuse investigation?        Yes        No       

 

Was the right exercised?           Yes          No

 

Were audio tapes made of any interviews?        Yes     No

 

Were video tapes made of any interviews?       Yes      No

 

Was any action taken to protect the student during or as a result of the investigation?            Yes           No

 

If yes, describe:

____ student excused from school                       school employee placed on administrative or other leave

___ student assigned to different class               other (please specify)

 

Level I investigator's conclusions:

   ____    The complaint is being dismissed for lack of jurisdiction.
 
   ____    Physical abuse was alleged, but no allegation of injury was made.
 

   ____   Physical abuse was alleged, but no evidence of physical injury exists and the nature of the

              alleged incident makes it unlikely an injury, as defined in the rules, occurred.

 
  ____   Sexual abuse was alleged, but the alleged actions of the school employee, even if true,

              would not meet the definition of sexual abuse in the rules.

 
 _____  Alleged victim was not a student at the time of the incident.
 

 _____   Alleged school employee is not currently employed by this school district.

 

 _____   Alleged incident did not occur on school grounds, on school time, at a school-sponsored activity, nor in a school-related context.

 

 ____    The complaint has been investigated and concluded at Level I as unfounded.

 

 ____   Complaint was withdrawn.

 

 ____   Insufficient evidence exists that an incident of abuse, as defined in the rules, took place.

 

 ____   The complaint has been investigated at Level I and is founded.

 

 ____  The investigation is founded at Level I and is being turned over to Level II for further investigation.

 

 ____    Investigation of the complaint was deferred at Level I and referred to law enforcement at this time.

 

 ____   The investigation is concluded at Level I because the accused school employee has admitted the violation, has resigned,

             or has agreed to relinquish any teaching license held.

    

Current status of investigation:

 

 ____   Closed.  No further investigation is warranted.

 

 ____   Closed and referred to school officials for further investigation as a personnel matter.

 

  ____   Deferred to law enforcement officials.

 

  ____  Turned over to Level II investigator.

 

Other comments:                                                                                                                                            

 
 

I have given a copy of the report of abuse and of this investigative report to the employee named in the report, the employee's supervisor, and the student's parent or guardian and informed the person filing the report of the options of contacting law enforcement, private counsel, or the State Board of Educational Examiners, if the accused school employee holds an Iowa teacher's certificate or license.

 

____________________________         ___________________________ 

Name of investigator (please print)       Investigator's place of employment

 

                                                                                        

Signature of investigator         Date

 
 
 
Approved 8/18/11          Reviewed 10/21/20              Revised
 
 

 

 
kkurt@northlin… Fri, 02/12/2016 - 13:40