Code No. 4O2.3E2
ABUSE OF STUDENTS BY SCHOOL DISTRICT EMPLOYEES
Report of Level I Investigation
Student's name: _____________________________________________________________
Student's age: ______________________________________________________________
Student's grade: ____________________________________________________________
Student's address: __________________________________________________________
Student's school: ___________________________________________________________
Name of accused school employee: __________________________Building___________
Name and address of person filing report: ___________________________________
Name and address of student's parent or guardian, if different from person filing report: _____________________________________________________________________________
Date report of abuse was filed: ______________ physical _____ sexual _____
Describe the nature, extent and cause of the student's injury, if any and if known: (Attach additional pages if needed). ________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Describe your investigation: Attach additional pages if needed. (Please do not use student witnesses' full names.): ___________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Were parent(s) or guardian(s) advised of their right to see and hear any interview of their pre-kindergarten through sixth grade children who are alleged victims of or a witness in a sexual abuse investigation? Yes No
Was the right exercised? Yes No
Were audio tapes made of any interviews? ___yes ___no
Were video tapes made of any interviews? ___yes ___no
Was any action taken to protect the student during or as a result of the investigation? ___yes ___no
If yes, describe:
_____student excused from school
_____school employee placed on administrative or other leave
_____student assigned to different class
_____other (please specify_______________________________________________
Level I investigator's conclusions:
_____The complaint is being dismissed for lack of jurisdiction.
_____Physical abuse was alleged, but no allegation of injury was made.
_____Physical abuse was alleged, but no evidence of physical injury exists and the nature of the alleged incident makes it unlikely an injury, as defined in the rules, occurred.
_____Sexual abuse was alleged, but the alleged actions of the school employee, even if true, would not meet the definition of sexual abuse in the rules.
_____Alleged victim was not a student at the time of the incident.
_____Alleged school employee is not currently employed by this school district.
_____Alleged incident did not occur on school grounds, on school time, at a school-sponsored activity, nor in a school-related context.
_____The complaint has been investigated and concluded at Level I as unfounded.
_____Complaint was withdrawn.
_____Insufficient evidence exists that an incident of abuse, as defined in the rules, took place.
_____The complaint has been investigated at Level I and is founded.
_____The investigation is founded at Level I and is being turned over to Level II for further investigation.
_____Investigation of the complaint was deferred at Level I and referred to law enforcement at this time.
_____The investigation is concluded at Level I because the accused school employee has admitted the violation, has resigned, or has agreed to relinquish any teaching license held.
Current status of investigation:
_____Closed. No further investigation is warranted.
_____Closed and referred to school officials for further investigation as a personnel matter.
_____Deferred to law enforcement officials.
_____Turned over to Level II investigator.
Other comments:
I have given a copy of the report of abuse and of this investigative report to the employee named in the report, the employee's supervisor, and the student's parent or guardian and informed the person filing the report of the options of contacting law enforcement, private counsel, or the State Board of Educational Examiners, if the accused school employee holds an Iowa teacher's certificate or license.
Name of investigator (please print) _________________________________________
Investigator's place of employment _________________________________________
Signature of investigator ___________________________________________________
Date _______________________________________________________________________
Approved 5-20-2019 Reviewed 3-20-2023