RICHMOND PUBLIC SCHOOLS Discipline Data Form 1 Time _______ Student Number ____________Incident Number___________ Grade____ Date mm/dd/yyyy Student Name _______________________________DOB Last First MI Referred By ____________________ mm/dd/yyyy Enrolled Div. No. ______ Enrolled School No. ____ Incident Div. No._______ Incident School No. _______ Parent Contacted (Telephone/Time) _____________/_______ Location of Incident __________Off. Date ________ mm/dd/yyyy Admin Action Offense Code Primary Off. 2 Days Spec. Ed Off. 3 Brief Description: OFFENSES DESIGNATED WITH AN * TO BE USED FOR IDENTIFYING PERSISTENTLY DANGEROUS SCHOOLS Alcohol Bullying AC1. Alcohol Use AC2. Alcohol Possession AC3. Alcohol Sale or Distribution BU1. Bullying Arson/Actual/Attempted AS1. Arson Actual AS2. Arson Attempted AS3. Lighted Firecrackers/ Cherry Bombs/Stink Bombs/Contribute to a Damaging Fire Assault/Battery * BA1. Assault/Battery/ Firearm or Other Weapon/Staff BA2. Assault/Battery/No Weapon/Staff * BA3. Assault/Battery/Firearm or Other Weapon/Student BA4. Assault/Battery/No Weapon/Student * BA5. Maliciously Wounding without Weapon Attendance A1T. Attendance - Violations of State, School Division or School Policy relating to Attendance Bomb Threat/False Threats BB1. Bomb Threat BO4. Setting off False Fire Alarm Breaking and Entering/Burglary BK1. Burglary/Actual BK2. Burglary/Attempted Disorderly Conduct D1C. D2C. D3C. D4C. Disrespect/Walking Away Defiance/Refuses Request Disruptive Demonstrations Possession of Obscene/ Disruptive Literature D5C. Classroom/Campus Disruption D6C. Obscene/Inappropriate Language/Gestures D8C. Minor Insubordination Drug Violations D4G. Unauthorized Over the counter Med\Use D5G. Unauthorized Over the Counter Med/Possession D6G. Over the Counter Med Sale/Distribution DG7. Marijuana Use DG8. Marijuana Possession DG1. Schedule I & II Use DG2. Schedule I & II Poss. * DG3. Schedule I & II Sales and Distribution * DG9. Marijuana Sale/Distribution D10. Other Drug Use/Overdose D11. Other Drug Possession/ Paraphernalia D12. Other Drug Sale/Distribution D15. Possession of Inhalants D16. Use of Inhalants D17. Substances Represented as Drugs (Look-alikes) * D19. Anabolic Steroid Sale/Dist. D20. Anabolic Steroid Use and Poss. DR3. Theft or Attempted Theft of Prescription Medication Electronic Devices/ Inappropriate Use C1M. Beepers C2M. Cellular Telephones C3M. Other Electronic Devices Extortion ET1. Extortion ET2. Attempted Extortion Fighting/Conflict FA2. Fighting/No or Minor Injury/Mutual Participation F1T. Altercation/Confrontation/ No Injury Gambling G1B. Gambling Gang Activity GA1. Gang Activity Harassment HR1. Harassment Hazing H1Z. Hazing Homicide *HO1. *HO2. *HO3. *HO4. Homicide vs. Staff/Firearm Homicide vs. Student/Firearm Homicide vs. Staff/Other Weapon Homicide vs. Student/Other Weapon RICHMOND PUBLIC SCHOOLS Discipline Data Form Inciting a Riot Threats/Verbal/Physical RG1. Inciting a Riot RG2. Attempting to Incite a Riot TI1. TI2. Threat/Intimidation vs. Staff/Physical/Verbal Threat/Intimidation vs. Student/Physical/Verbal Kidnapping *KI1. Kidnapping Other Violations S1V. Inappropriate Personal Property S2V. Misrepresentation/ Other Violations S3V. Other School or Code of Conduct Violation not otherwise included OT1. Failure to Display School ID Theft/No Force TF1. TF2. TF3. TF4. TF6. Theft/School Property Theft/Staff Property Theft/Student Property Possession/ Stolen Property Attempted Theft or Theft of Motor Vehicle Tobacco Offenses Robbery/Person/Force or Threat of Force *RB1. Actual *RB2. Attempted TC1. TC2. TC3. T4B. Codes Requiring Victim Counts BA1 BA2 BA3 BA4 BA5 BU1 EX1 ET1 ET2 H1Z HO1 HO2 HO3 HO4 HR1 KI1 RO1 RB1 RB2 SB1 SB2 ST1 SX0 SX1 SX2 SX3 SX4 SX5 SX6 SX8 TH1 TF1 TF2 TF3 TF4 TH2 TF6 TI1 TI2 SX7 May or may not have victim count Tobacco Use Tobacco Possession Tobacco Sale/Distribution Bringing Tobacco Paraphernalia to School/ School Event Stalking ST1. Stalking Trespassing TR1. Trespassing Sexual Offenses SB1. SB2. SX0. SX1. SX2. Sexual Battery against Staff Sexual Battery against Student Sexual Harassment Offensive Sexual Touching/Staff Offensive Sexual Touching/Student Sexual Assault Staff/Rape Sexual Assault Student/Rape Attempted Sexual Assault/Staff/Rape Attempted Sexual Assault/Student/Rape Sexual Offense w/out Force/Lewd Behavior/Indecent Exposure Aggravated Sexual Battery/Student less than age 15 Vandalism VN1. Vandalism of School Property VN2. Vandalism of Private Property VN3. Graffiti Weapons WP0. Pneumatic Weapon-BB, Pellet, or Paint ball Gun *WP1. Weapon Handgun/ Pistol *SX5. *WP2. Weapon Shotgun/Rifle *SX6. WP3. Toy/Look-alike Gun to School/Event SX7. W1P. Possession of Ammunition W2P Possession of Chemical Substance *SX8. *WP4. Weapon, Expels a Projectile WP5. Knife to School/Event *WP6. Possession of Explosive Technology Use Violations Device/Live Ammunition T1C. Unauthorized Use of Technology or *WP7. Use of Bomb or Explosive Device Information *WP8 Zip Gun/Starter Gun/Flare Gun T2C. Causing/Attempting to Cause Damage to WP9. Other Weapons Computer/Hardware, Software/Files WT1. Taser T3C. Violation of Acceptable Use Policy WS1. Stun Gun T4C. Violation of Internet Policy W8P. Razor Blades, Box Cutter to School/School Event W9P. Fireworks/Firecrackers/Stink Bombs at School/School Event *SX3. *SX4. Principal. /Assist. Principal: __________________________ Date entered into collection: _____________ Entered by: ___________________ mm/dd/yyyy