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TO: All Employees
FROM: District Administrator
Providing safe and healthful conditions for all our students, employees and visitors is a high priority in the School District of Auburndale. I strongly encourage anyone who is aware of any unsafe condition, in or around their school bundling, to complete this form and present it to the building principal immediately. The District is committed to taking corrective action on all issues brought to our attention. After we have made an investigation, you will be notified of the action taken to correct the problem.
Thank you in advance for your concern.
Please fill out the following:
Individual completing this form: Name______________________________________________
Date_________________________ Building________________________________________
Description of unsafe condition:
PRESENT COMPLETED FORM TO BUILDING PRINCIPAL IMMEDIATELY!
For Office Use. Note to building principals: Take immediate action if you can. Send a copy of this form to the Administrative Assistant at the District Office and follow the regular procedure for dealing with safety issues.
Corrective action taken:
Administrator’s Name________________________________________ Date________________
Signature_____________________________________________
Date of response given to person reporting unsafe condition:_____________________
Adopted: March 15, 2000
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