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Violent Incident Tracking Form


1. The INCIDENT REPORT form should be used to document violent behaviour and/or conduct in the workplace that the teacher believes is not conducive to a safe and healthy working environment.

2. This form should where possible be completed and submitted within 24 hours of the occurrence or discovery of the behaviour/conduct in question.

3. Completed INCIDENT REPORT forms should be submitted immediately as follows:
– One copy retained by the NLTA member completing the form; ( Please Note: a copy will automatically be emailed to the email address you have provided on your submitted form) and,
– One copy submitted to the NLTA office – press SEND FORM after completing the form,
– or you may print and fax to 726-4302 or 1-877-711-6582.

This form is CONFIDENTIAL and MUST NOT be distributed other than as noted above.
PLEASE NOTE: This form will only be used for research for Collective Bargaining purposes. If you require information or assistance with respect to a particular incident or situation, please contact an Administrative Officer in Programs and Services at