406.2E2 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: _____________________________________________________

Allegation is of  ________ Physical abuse  ________ Sexual abuse*

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/as a result of the investigation?

_______ yes ________ no

If yes, describe:

________student excused from school                 ________school employee placed on 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.

            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 _________________________________________________________________________

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Adopted: 2/9/09

Reviewed: 10/14/19

Revised: 4/8/13