Attachment 6b Event Report.pdf
PDF 492 KB Posted
- Attached to
- RESIDENTIAL CAMPS FOR SCDJJ
- Solicitation number
- 5400028089
- Issued by
- Georgetown County, South Carolina
About this file
The document is a South Carolina Department of Juvenile Justice (SCDJJ) Event Report Form (Form 326A, dated 03-2022), designed for reporting non-DJJ staff events. This standard form provides a structured template for documenting incidents involving juveniles, with sections for Event Reporting Service (ERS) information, event details, individuals involved, and a description of the event. The form includes fields to capture critical information such as date and time of the event, facility location, names and demographics of individuals involved, and a space for a detailed event description.
The form includes a medical treatment information key that defines different levels of medical response (Serious, Minor, None, Refused), and contains a non-discrimination statement for the SCDJJ School District. The document is designed to standardize incident reporting, allowing staff to comprehensively record events while providing space for evidence, attached documents, and other significant information. The form also includes contact information for Title IX and 504 Special Education Office inquiries, emphasizing the department's commitment to transparency and procedural documentation.
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Other files
| File | Type | Posted |
|---|---|---|
| Amendment One.docx | DOCX document | |
| Amendment Two.docx | DOCX document | |
| Attachment 2 Facility Maint.docx | DOCX document | |
| Attachment 8 Security Assessment Questionnaire.doc | DOC document | |
| Attachment 6 Event Report Policy.pdf | ||
| Attachment 4 Mthly Prog Report.xlsx | XLSX spreadsheet | |
| Attachment 6a Reqs Event Report.pdf | ||
| Attachment 7 Critical Incident Report.pdf | ||
| Attachment 3 Educ Stds.docx | DOCX document | |
| Solicitation.docx | DOCX document | |
| Attachment 1 State Stds.docx | DOCX document |
Show all 11
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Text version
SOUTH CAROLINA DEPARTMENT OF JUVENILE JUSTICE
Form 326A 03-2022
SCDJJ Event Report (Non-DJJ staff report)
ERS INFORMATION:
ERS Priority:
Priority 1/Priority 2
Reported via Phone and/or /Email
Date
Reported
Time
Reported
Reporter’s Name Title: ERS
NUMBER
Phone Email:inspectorgeneralev entreporting@scdjj.net
EVENT INFORMATION:
Date of Event Time of Event Facility/Office Where Event Occurred
Date of This Report Time of This Report Specific Area within Facility Office Where Event Occurred
Name(s) of Juvenile(s) Involved JJMS#(s) Assigned Facility/Unit Race Gender Age V=Victim P=Perpetrator
W=Witness
** Medical Treatment
(See Key)
Name(s) of Other Person(s)
Involved (Not juveniles)
S=Staff V=Volunteer
O= Other
Contact Phone # Race Gender Age V=Victim P=Perpetrator
W=Witness
Description of the Event (This section will expand with typing, as necessary or use supplemental report)
Evidence, Attached Documents, Other Significant Information
Print Name of Employee
Writing This Report
Title
Signature of Person
Writing This Report
Date
** Medical Treatment Information Key Serious = Treated by a Doctor, Nurse Practitioner, or Emergency Medical Technician None= No medical treatment was necessary.
Minor = 1st Aid Treatment (ice pack, band aid, ointment, etc.) Refused = Juvenile refused medical treatment (Juvenile signs refusal form with the medical staff)
The South Carolina Department of Juvenile Justice’s School District also does not discriminate in any programs or activities on the basis of race, color, national origin, sex, disability or age. The following offices have been designated to handle inquiries regarding the school district’s nondiscrimination policies: Title IX - Inspector General's Office
– 220 Executive Center Drive, Winthrop Building, Columbia, SC 29210 – Ph: 803-896-9595; 504 Special Education Office, 220 Executive Center Drive, Winthrop Building, Columbia, SC 29210 – Ph: 803-896-8484.
| ERS Priority Priority 1Priority 2Row1: |
| Date Reportedinspectorgeneralevent reportingscdjjnet: |
| Time Reportedinspectorgeneralevent reportingscdjjnet: |
| Reporters Nameinspectorgeneralevent reportingscdjjnet: |
| Titleinspectorgeneralevent reportingscdjjnet: |
| ERS NUMBERinspectorgeneralevent reportingscdjjnet: |
| Date of EventRow1: |
| Time of EventRow1: |
| FacilityOffice Where Event OccurredRow1: |
| Date of This ReportRow1: |
| Time of This ReportRow1: |
| Specific Area within Facility Office Where Event OccurredRow1: |
| Names of Juveniles InvolvedRow1: |
| JJMSsRow1: |
| Assigned FacilityUnitRow1: |
| RaceRow1: |
| GenderRow1: |
| AgeRow1: |
| VVictim PPerpetrator WWitnessRow1: |
| Medical Treatment See KeyRow1: |
| Names of Other Persons Involved Not juvenilesRow1: |
| SStaff VVolunteer O OtherRow1: |
| Contact Phone Row1: |
| RaceRow1_2: |
| GenderRow1_2: |
| AgeRow1_2: |
| VVictim PPerpetrator WWitnessRow1_2: |
| Description of the Event This section will expand with typing as necessary or use supplemental reportRow1: |
| Evidence Attached Documents Other Significant InformationRow1: |
| Print Name of Employee Writing This Report: |
| Title: |
| Signature of Person Writing This Report: |
| Date: |
| Check Box1: Off |
File details come from the government source that posted it. Updated .