Aggressive Incident Reporting - Simcoe County District School Board

Administrative Procedures
Memorandum A4071
Page 1 of 9
Date of Issue: May 2013
Original Date of Issue: January 30, 2008
Subject:
AGGRESSIVE INCIDENT REPORTING
References: Occupational Health and Safety Act (R.S.O. 1990)
Workplace Safety and Insurance Act
Occupational Health and Safety Procedures
APM A1440 Physical Containment – Guidelines for Responding to
Injurious and Self-Injurious Student Behaviour
APM A4002 Reporting of Workplace Injury/Illness
APM A7635 Student Discipline Procedures
APM A7100 Violent Incidents – Response Procedures
Board Policy 3140 Health and Safety
Board Policy 3045 Workplace Violence
Board Policy 4240 Safe and Caring School Cultures
Board Policy 4250 Student Discipline
Links: FORM A4071 -1, FORM A1440 -1, FORM A7100 -1, FORM A4002 -1
Contact:
Business Services
1. Purpose
1.1 This Administrative Procedures Memorandum (APM) provides guidance to
employees of the Simcoe County District School Board for reporting aggressive
incidents affecting employees that are not covered under the Workplace Safety
and Insurance Act and ensures that the appropriate individuals are aware of and
can respond to the aggressive incident. Note: the reporting forms for this APM
are not to be completed for aggressive incidents between students.
1.2 Personal information of employees collected on the Aggressive Incident form will
be used to determine appropriate board safety responses and shall not be
disclosed for any other purpose, except in compliance with the Municipal
Freedom of Information and Protection of Privacy Act and appropriate board
authorization. No information that personally identifies a student or non-board
employee (i.e. name, initials) shall be recorded on the forms.
2. Definitions
2.1 An aggressive incident is any physical, verbal or non-verbal incident or injury which
results in an employee feeling threatened for his/her safety and security.
Aggressive incidents could involve a student, parent, co-worker or visitor.

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Memorandum A4071
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3. General
3.1 Under the Occupational Health and Safety Act, section 25(2)(h), employers are
responsible to take every precaution reasonable in the circumstances for the
protection of the worker and shall advise workers of the existence of any
potential or actual danger to the health and safety of the worker of which the
employer is aware.
3.2 Every employee has the responsibility to report to his/her supervisor any health
and safety issue that endangers his/her safety and security.
3.3 In situations involving an employee and student where the police are involved
pursuant to APM A7100 Violent Incident - Response Procedures, the Aggressive
Incident Reporting form (FORM A4071 - 1 or A4071 - 2) is completed in addition to
the Violent Incident form (FORM A7100 - 1). See APM A7100 Violent Incident -
Response Procedures.
3.4 In situations where there is an aggressive incident involving an employee and a
student is restrained, the Aggressive Incident Reporting form (FORM A4071 – 1 or
A4071 - 2) is completed in addition to the Physical Containment Incident Report
(FORM A1440 - 1). See APM A1440 Physical Containment: Guidelines for
Responding to Injurious and Self-Injurious Behaviour.
3.5 If the employee is injured and requires first aid or medical attention, APM A4002
Reporting of Workplace Injury/Illness must be followed, and the Report of
Workplace Injury or Illness form (FORM A4002 - 1) must also be completed. See
APM A4002 Reporting of Workplace Injury/Illness.
4. Procedure
4.1 Permanent Employees
As soon as possible after an aggressive incident occurs, permanent employees
shall report the incident to their supervisor by logging into the staff website,
completing the Employee section (section one) of the on line Aggressive Incident
Reporting form (FORM A4071 - 1) and submitting it electronically to their
supervisor. FORM A4071 - 1 can be accessed on the staff website under the
Corporate Risk – Health and Safety section.
4.1.1 The Employee section of the form outlines employee information and
details of the incident.
4.1.2. The employee shall ensure that the aggressor is not named and any
students involved are not identifiable in the Employee section of the form.
4.1.3 If necessary, the form can be partially completed, saved and completed at
a later time; however, the Employee section of the form must be completed
and submitted before a new form can be started.
4.1.4 Once the form is completed, it is submitted electronically to the employee’s
supervisor by clicking on the “Submit to Supervisor” button. The
employee’s supervisor will receive an email notification that an Aggressive
Incident Reporting form has been submitted. The supervisor can view the
form from the notification.

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Memorandum A4071
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4.1.5 If an employee is absent from work and is unable to complete the
Aggressive Incident Reporting form, they may contact their supervisor and
outline the details of the incident verbally. The employee shall complete
the Aggressive Incident Reporting form upon their return to work.
4.1.6 When a supervisor receives an email notification of an on line Aggressive
Incident Reporting form being submitted, they shall meet with the
employee, review the incident and complete the Supervisor section
(section two) of the on line form. The supervisor shall indicate all actions
that will be initiated as a result of the aggressive incident and when such
actions will occur.
4.1.6.1 The supervisor shall ensure that the aggressor is not named and
any students involved are not identifiable in the Supervisor and
Employee sections of the form.
4.1.6.2 The supervisor will not have access to input information into the
Employee section of the form.
4.1.6.3 The supervisor shall submit the completed form by clicking the
“SUBMIT” button. Upon submission, the form will be saved in the
Aggressive Incident on line program and an email notification will
be sent to the employee indicating the supervisor has submitted
the form.
4.1.6.4 The supervisor shall submit the completed form within three (3)
working days of the email notification being received. A reminder
email will be sent to the supervisor if the form has not been
submitted within this time period.
4.1.6.5 If the supervisor determines that modifications to the form are
required prior to submission (i.e. form is incomplete, aggressor
named or students involved identified), the supervisor can return
the form to the employee by clicking the “Return to Employee”
button. An input field is available for outlining the reason for
returning the form. The employee will receive an email notification
that the form has been returned.
4.1.7 Only Aggressive Incident Reporting forms (FORM A4071 - 1) submitted
electronically through the staff website will be accepted.
4.1.8 To assist with making informed decisions regarding interactions in their
work location, employees may access submitted Aggressive Incident
Reporting forms (for their work location) under the Corporate Risk –
Health and Safety section of the staff website.
4.1.8.1 Aggressive Incident Reporting forms shall remain on the staff
website for the current school year.
4.2 Non-Permanent Long-Term Assignment Employees
As soon as possible after an aggressive incident occurs, non-permanent long-term
assignment employees (long-term occasional teaching assignment and long-term
temporary assignments for support staff) shall report the incident as per item 4.1.
4.3 Non-Permanent Employees
As soon as possible after an aggressive incident occurs, non-permanent employees
(i.e. casual, temporary, occasional) shall report the incident by completing the
Employee section (section one) of FORM A4071 - 2, Aggressive Incident Reporting

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Memorandum A4071
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form for non-permanent employees (hard copy), and forwarding it to the location
supervisor.
4.3.1 The Employee section of the form outlines employee information and details
of the incident.
4.3.2 A hard copy of FORM A7071 - 2 shall be made available at each board site,
upon request.
4.3.3 The employee shall ensure that the aggressor is not named and any
students involved are not identifiable in the Employee section of the form.
4.3.4 The completed form shall be forwarded to the location supervisor as soon
as possible. If the employee is no longer working at the site they shall send
the form to the location supervisor using the board’s courier system.
4.3.5 The supervisor shall review the form and complete the Supervisor section
(section two) of the form outlining all actions that will be initiated as a result
of the aggressive incident and when such actions will occur.
4.3.5.1 If the employee is still working at the location where the
aggressive incident occurred, the supervisor shall meet with the
employee, review the incident and complete the Supervisor
section (section two) of the form with the employee.
4.3.5.2 If the employee is no longer working at the location, the
supervisor shall complete the Supervisor section of the form
based on the information contained in the Employee section. If
the Supervisor requires further information on the incident, they
may contact the employee to discuss the incident using the
contact information provided on the form, where applicable.
4.3.5.3 The supervisor shall ensure that the aggressor is not named and
any students involved are not identifiable in the Supervisor and
Employee sections of the form.
4.3.6 The supervisor shall send a copy of the completed form to Corporate Risk –
Health and Safety within three (3) working days of receiving the form.
4.3.6.1 The information contained in the form will be summarized and
entered into an Aggressive Incident on line program.
4.4 Aggressive Incident On line Program
The Aggressive Incident on line program stores submitted Aggressive Incident
Reporting forms and tracks the number of aggressive incidents by location.
Aggressive Incident Summary reports are created from the stored data. The
Aggressive Incident on line program is located under the Corporate Risk – Health
and Safety section of the staff website.
4.4.1 The Superintendents of Education and the Special Education - Itinerant
Department will have access to the Aggressive Incident on line program to
view/print Aggressive Incident Reporting forms and Aggressive Incident
Summary reports for the purpose of ensuring that appropriate action has
been taken.
4.4.2 The Joint Health and Safety Committee shall have access to the Aggressive
Incident on line program to view/print submitted Aggressive Incident
Reporting forms and the Aggressive Incident Summary reports for the
purpose of making recommendations on health and safety matters under
the Occupational Health and Safety Act.

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Memorandum A4071
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4.4.2.1 Personal information on Aggressive Incident Reporting forms or
the Aggressive Incident Summary reports shall not be used or
disclosed by Joint Health and Safety Committee Members to
external parties, including union representatives, except in
compliance with the Municipal Freedom of Information and
Protection Act and appropriate Board authorization.
4.5 Corporate Risk – Health and Safety shall manage the Aggressive Incident on line
program.
4.5.1 Submitted Aggressive Incident forms are reviewed and when approved will
be archived into the Aggressive Incident on line program. If modifications to
a form are necessary, it will be sent electronically back to the supervisor
with an explanation of the modifications required.
4.5.2 If necessary, submitted Aggressive Incident Reporting forms will be
modified to ensure that the aggressor is not named and any students
involved are not identifiable.
4.5.3 Aggressive Incident Reporting forms shall be saved for a period of two (2)
years from submission.
First Issued January 30, 2008
Revised February 2010, May 2011, May 2013
Issued under the authority of the Director of Education

Aggressive Incident Reporting Form
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Memorandum A4071
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FORM A4071 - 1a

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Memorandum A4071
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FORM A4071 - 1b

Name:
Position:
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Memorandum A4071
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FORM A4071 - 2a
AGGRESSIVE INCIDENT REPORTING FORM FOR NON-PERMANENT EMPLOYEES
Employee Number:
Work Location:
SECTION ONE – EMPLOYEE SECTION
Affiliation:
Elementary Occasional
Secondary Occasional
OPSEU Occasional
CUPE Occasional
Contact Information (optional): Phone #
Email
Location Supervisor’s Name:
DETAILS OF INCIDENT
(COMPLETE ONE FORM PER DAY IF SAME AGGRESSOR)
Repeat Incident(s) Involving same aggressor: Yes No If yes, number of incidents:
Date of Incident(s):
Time of Incident(s):
a.m.
p.m.
Location of Incident(s): (check all that apply)
Hallway Gym Stairs
Classroom Office Washroom
Field Trip Parking Lot Yard
School Vehicle
Other:
Aggressor:
Co-worker Student Parent Visitor
Other:
Site of Incident(s)
Nature of Incident(s): (check all that apply and indicate number
of occurrences)
Verbal/Non Verbal Aggression
Shouting
Swearing
Threat
Repeated Non-Compliance
Physical Aggression
Bite
Grab
Intimidation
Kick
Pinch
Other:
Punch
Scratch
Slap
Spit
Threat
Weapon(s) Involved: Yes No If yes, indicate item:
Employee Injuries Sustained: (indicate body part(s):
Description of incident (Include what lead up to the incident. Please do not include the aggressor’s name or identify
students involved
Signature: _____________________________
Date Report Sent to Location Supervisor: ___________________

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Memorandum A4071
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FORM A4071 - 2b
SECTION TWO – SUPERVISOR SECTION
Action Initiated: (check all that apply)
Review IEP and/or Behaviour
Management Plan, if applicable
Develop/Review/Revise Safety Plan
Description of Action Initiated
(Please ensure that the aggressor is not named and
students involved are not identifiable).
When will
Action be
Initiated?
Safety Plan Shared with Appropriate
Staff
Modification to Work Environment
Community Agency Support Referral
Police Involvement
Staff Training/In-Service
Employee Personal Protective
Equipment:
Available and Used Available
but not used Required
Risk Assessment (in consultation with
the Superintendent of Education)
Other
Has the aggressor been involved in any previous incidents: Yes No Unknown
Have the following forms been completed, if
applicable? (Refer to the appropriate APM for further
information)
A7100-1 Violent Incident Form
A1440-1 Physical Containment Reporting Form
A4002-1 Reporting of Workplace Injury/Illness Form
Complete which applies:
Meeting held with employee on
Employee contacted on
Employee not contacted
Supervisor Name:
Date:
Supervisor Signature:
The completed form shall be sent to Corporate Risk – Health and Safety at the Education Centre within three (3) working days of
receiving the form.
Information collected on this form is collected in accordance with the Occupational Health and Safety Act and the with the Municipal Freedom of
Information and Protection of Privacy Act. Information will be used for the purpose of staff and student safety. Questions regarding information
collected on this form should be referred to Corporate Risk – Health and Safety at the Education Centre.