Safety Survey

Safety Survey


  1. Date: *
  2. Name: (Optional)
  3. Prefix:
  4. First Name:
  5. Middle Name:
  6. Last Name:
  7. Suffix:
  8. Contact Phone Number: Ext:
  1. School: *
  2. Grade Level: *
  3. Were you (or if you are a parent, was your child) harassed this academic year? * Yes No
  4. Did you report the incident? * Yes No
  5. If no, why did you not report the incident?
  6. If you did not report the incident, what would have facilitated the reporting of the incident?
  7. What happened? How did the incident occur
  8. When did the incident occur?:
  9. Where did the incident occur?
    (Please provide the location of the incident.)
  10. Who was the harasser(s)?
  11. Who were witnesses, if any?

Victor Valley Union High School District's Governing Board and administration is committed to maintaining an educational environment that is free from harassment. The District prohibits harassment of any kind, including harassment based on sex, of any student by another student, an employee or other person, at school or at a school-sponsored or school-related activity. The District also prohibits retaliatory behavior or action against any person who complains, testifies, assists or otherwise participates in the complaint process established in accordance with the District's policy and administrative regulation. It is the position of this District that sexual harassment is unlawful and will not be tolerated.

If you would like to report an incident at your school but would prefer talking to someone in person, please contact the Principal or the designee at your school site. Alternatively, please contact the Assistant Superintendent of Educational Services (760-955-3201 x10320). Reports and investigation are confidential. Thank you for responding to this survey.

Security Measure
  • Victor Valley Adult School