NJ SSDS Incident Report Form

Introduction

This report is used to extract SSDS and/or HIB information from Incident Management. Only NJ SSDS State Reportable incidents are included.

Selection Criteria

Selection criteria determine which database records are used in the report.

Incident Selection Criteria

Incident Type must be STATE REPORTABLE (SSDS)^
Incident Date must occur between the Incident Start Date and Incident End Date
Incident school, not participant school, is used to select the Incidents to report (unless run from the District Office and the "All Schools" option is selected)
If an incident is flagged with HIB ALLEGED = YES, or HIB CONFIRMED = YES, the report includes a section on harassment, intimidation, and bullying
If the incident has more than one offender, all behaviors are reported together on the first page of the report

Offender Selection Criteria

Unknown offenders are not reported.
Offender count includes staff and non-student offenders, but does not include unknown offenders
Offender information is repeated for as many offenders as are defined for an Incident. This includes students "from another school" and non-students, as long as they are known offenders.
"Educational Services Provided During Suspension" is reported as Yes only if Participant Attribute PROGRAM SERVICES PROVIDED^ is set to EDUC. PROGRAM (ACADEMIC INSTRUCTION/SUPPORT)^.
"Did the offender receive other disciplinary action?" is reported as Yes when any other Action exists that is not ISS, OSS, or a Removal Action (for example, OTHER, DETENTION, SUSPENSION OF PRIVILEGES).

Victim Selection Criteria

Both HIB and non-HIB incident victims are reported in the Count of Victims on page 1.
Only victims of HIB Incidents who attend the school where the incident occurred are reported with name and demographic information on page 3.

Character limitations

Only the first 100 characters of the Incident Description are reported.
Only the first 300 characters of the Gun Free Schools Act comment are reported.

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Report Input

For help with navigation and running the report, see How to Find and Generate a Report.

Field	Description
Select Schools	If run at the district level, choose one of the following: Select Multiple Schools – Select schools to include in the report. To select a single school, click that school. To select multiple schools, use Ctrl+Click and select each school to be included. All Schools – Run the report for the entire district. If run at the school level, the report includes all records associated with the current school that meet the selection criteria. To change the current school, click School at the top of the page and choose the appropriate school from the list.
Select School Year	Select the school year in which the incident occurred.
Incident Start Date (will report incidents on or after this date)	Enter the Incident Start Date. Incidents on or after this date will be reported. If an Incident End Date is selected, only incidents on or after the start date and on or before the end date will be reported.
Incident End Date (will report incidents on or before this date)	Enter the Incident End Date. Incidents on or before this date will be reported.
Scheduling	Select one of the following: Run Now – Run the report immediately. Schedule – Choose a date, start time, and/or frequency to run the report.

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Report Output

Each of the fields displayed in the output of the report are described below. See Understanding the Report Output Table for a definition of each column in the table.

Item #	Data Element	Description	[Table]FieldName	Field Length
1	School Name	The name of the school reporting the incident.	[Schools]Name	60
2	Date of Incident	The date the incident occurred.	[Incident]Incident_TS	6
3	Incident Description	The incident description.	[Incident]Incident_detail_desc	100
4	Incident Type	Indicates the type of disciplinary behaviors this incident involves. There can be multiple offenses in one incident. See the Appendix for a full list of behavior codes and subcodes.	[Incident_LU_Code]Code_Type=behaviorcode [Incident_LU_Code]Incident_Category [Incident_LU_Sub_Code]Sub_Category [Incident_LU_Sub_Code]State_Detail_Report_Code	1
5	Incident Location	Indicates the location of the incident: In school building At school entrance Outside of school building Off school grounds (HIB only) Both on and off school grounds	[Incident_LU_Code]Code_Type=locationcode [Incident_LU_Code]Incident_Category [Incident_LU_Sub_Code]Sub_Category [Incident_LU_Sub_Code]State_Detail_Report_Code	1
6	Reported to police?	Indicates whether the incident was reported to the police.	[Incident_LU_Code]Code_Type=attributecode [Incident_LU_Code]Incident_Category = POLICE NOTIFICATION^	1
7	Bias-Related	Indicates whether the incident was bias-related.	[Incident_LU_Code]Code_Type=attributecode [Incident_LU_Code]Incident_Category = BIAS RELATED^	1
7.1	If yes, did bias intimidation occur?	indicates whether bias intimidation occurred	[Incident_LU_Code]Code_Type=attributecode [Incident_LU_Code]Incident_Category = BIAS INTIMIDATION OCCURRED^	1
8	Number of known offenders	The number of known offenders in the incident.	[Incident_LU_Code]Code_Type=personcode [Incident_LU_Code]Incident_Category = Offender	1
9	Number of known victims	The number of known victims for each of the following categories: victim(s) at this school victim(s) from another school staff victim(s) other non-student victim(s) Total known victim(s)	[Incident_LU_Code]Code_Type=personcode [Incident_LU_Code]Incident_Category = Victim [Incident_LU_Sub_Code]Sub_Category = GENERAL EDUCATION STUDENT^ or STUDENT WITH DISABILITIES^ STUDENT FROM ANOTHER SCHOOL^ SCHOOL PERSONNEL^ NON-STUDENT (SPECIFY)^ calculated from the above	1
10	Was this a violent criminal offense?	Indicates whether this was a violent, criminal offense.	[Incident_LU_Code]Code_Type=participantattributecode [Incident_LU_Code]Incident_Category = VICTIM OF VIOLENT CRIMINAL OFFENSE (VICTIM ONLY)^	1
11	Transfer available to student victim(s)?	Indicates whether the victims of the offense were able to transfer schools after the incident.	[Incident_LU_Code]Code_Type=participantattributecode [Incident_LU_Code]Incident_Category = VICTIM TRANSFER OPTION AVAILABLE^	1
11.1	If no, explain why transfer option not available	An explanation of why the victims could not be transferred.	[Incident_Detail]Lookup_Code_Desc	512
11.2	If yes, was transfer completed within 30 days?	Indicates whether the victims were transferred within 30 days.	[Incident_LU_Code]Code_Type=participantattributecode [Incident_LU_Code]Incident_Category = VICTIM TRANSFER OPTION OUTCOME^ [Incident_LU_Sub_Code]Sub_Category = OPTION ACCEPTED, XFER COMPLETE WITHIN 30 DAYS^	1
11.2.1	If transfer was not completed within 30 days, explain why	An explanation of why the transfer was not completed within 30 days.	[Incident_Detail]Lookup_Code_Desc	512
Offender Information
12	Offender Type	Indicates the type of offender: Student at this school Student from another school Non-student	[Incident_LU_Code]Code_Type=personcode [Incident_LU_Code]Incident_Category = Offender [Incident_LU_Sub_Code]Sub_Category = GENERAL EDUCATION STUDENT^ or STUDENT WITH DISABILITIES^ STUDENT FROM ANOTHER SCHOOL^ NON-STUDENT (SPECIFY)^	1
13	First Name	The offender's first name.	[PSRW_INCIDENTPARTICIPANT]First_Name	30
14	Last Name	The offender's last name.	[PSRW_INCIDENTPARTICIPANT]Last_Name	30
15	NJ SMART Student ID	The offender's NJ SMART student ID number.	[Students]State_StudentNumber	10
16	Did the offender cause injury?	Indicates whether the offender caused injury to a victim.	[Incident_LU_Code]Code_Type=participantattributecode [Incident_LU_Code]Incident_Category = INJURY CAUSED (OFFENDER ONLY)^ [Incident_LU_Sub_Code]Sub_Category = MINOR INJURY^ or MAJOR INJURY^ or SERIOUS BODILY INJURY^	1
16.1	If yes, what injury did offender cause?	Indicates the level of injury the offender caused: Minor injury Major injury Serious Bodily Injury	[Incident_LU_Code]Code_Type=participantattributecode [Incident_LU_Code]Incident_Category = INJURY CAUSED (OFFENDER ONLY)^ [Incident_LU_Sub_Code]Sub_Category = MINOR INJURY^ MAJOR INJURY^ SERIOUS BODILY INJURY^	1
17	Was offender arrested?	Indicates whether the offender was arrested for the incident.	[Incident_LU_Code]Code_Type=participantattributecode [Incident_LU_Code]Incident_Category = ARRESTED^ [Incident_LU_Sub_Code]Sub_Category = YES^	1
18	Was offender suspended?	Indicates whether the offender was suspended from school for the incident.	[Incident_LU_Code]Code_Type=actioncode [Incident_LU_Code]Incident_Category = OUT OF SCHOOL SUSPENSION^ IN SCHOOL SUSPENSION^	1
19	Educational services provided during suspension?	Indicates whether the offender was provided educational services during the suspension.	[Incident_LU_Code]Code_Type=participantattributecode [Incident_LU_Code]Incident_Category = PROGRAM SERVICES PROVIDED^ [Incident_LU_Sub_Code]Sub_Category = EDUC. PROGRAM (ACADEMIC INSTRUCTION/SUPPORT)^	1
20	In-school suspension	The number of days the student was suspended in-school.	[Incident_LU_Code]Code_Type=actioncode [Incident_LU_Code]Incident_Category = IN SCHOOL SUSPENSION^ [INCIDENT_ACTION]duration_actual if duration_actual is blank, then [INCIDENT_ACTION]duration_assigned	1
21	Out-of-school suspension	The number of days the student was suspended out-of-school.	[Incident_LU_Code]Code_Type=actioncode [Incident_LU_Code]Incident_Category = OUT OF SCHOOL SUSPENSION^ [INCIDENT_ACTION]duration_actual if duration_actual is blank, then [INCIDENT_ACTION]duration_assigned	1
22	Total days suspended	The total number of days the student was suspended both in and out-of school.	calculated from the above durations	1
23	Other Removal type	Indicates whether the student was assigned one of the following forms of removal, other than suspension: None Removal to another school Removal to alternative education program Expulsion Unilateral removal Days - the number of days the student was unilaterally removed. Removal by hearing officer Days - the number of days the student was removed by a hearing officer. Removal to other	[Incident_LU_Code]Code_Type=actioncode [Incident_LU_Code]Incident_Category = no Removal actions REMOVAL TO ANOTHER SCHOOL^ REMOVAL TO ALT ED PROGRAM^ REMOVAL - EXPULSION^ REMOVAL - UNILATERAL^ REMOVAL BY HEARING OFFICER^ REMOVAL TO OTHER^ For 5 and 6, Number of Days = [INCIDENT_ACTION]duration_actual if duration_actual is blank, then [INCIDENT_ACTION]duration_assigned	1
24	Did the offender receive other disciplinary action?	Indicates whether the offender received another disciplinary action besides suspension/removal.	[Incident_LU_Code]Code_Type=actioncode [Incident_LU_Code]Incident_Category = any action other than ISS,OSS,or Removals	1
25	How was the Gun-Free Schools Act followed? (for weapons incidents involving air gun, handgun, rifle or bomb only)	An explanation of if/how the Gun-Free Schools Act was followed.	[Incident_LU_Code]Code_Type=attributecode [Incident_LU_Code]Incident_Category = GUN FREE SCHOOLS ACT^ [Incident_Detail]Lookup_Code_Desc	300
HIB Information Note: This section on harassment, intimidation, and bullying only appears on the report if the incident is set as an alleged or confirmed HIB incident.
26	Incident Investigated within 10 Days?	Indicates whether the incident was investigated within 10 days.	[Incident_LU_Code]Code_Type=attributecode [Incident_LU_Code]Incident_Category = HIB INVESTIGATED WITHIN 10 DAYS^ [Incident_LU_Sub_Code]Sub_Category = YES^	1
27	Lead Investigator First Name	The lead incident investigator's first name.	[Incident_LU_Code]Code_Type=attributecode [Incident_LU_Code]Incident_Category = HIB LEAD INVESTIGATOR - LAST NAME^ [Incident_Detail]Lookup_Code_Desc	30
28	Last Name	The lead incident investigator's first name.	[Incident_LU_Code]Code_Type=attributecode [Incident_LU_Code]Incident_Category = HIB LEAD INVESTIGATOR - FIRST NAME^ [Incident_Detail]Lookup_Code_Desc	30
29	Nature of HIB Incident	Indicates that the harassment, intimidation, or bullying incident pertains to one of the following protected categories: Race and/or color Religion Ancestry and/or origin Gender and/or gender identity & expression Sexual Orientation Mental, Physical, or Sensory Disability Other Distinguishing Characteristics	[Incident_LU_Code]Code_Type=attributecode [Incident_LU_Code]Incident_Category = HIB - PROTECTED CATEGORY^ [Incident_LU_Sub_Code]Sub_Category = RACE^ and/or COLOR^ RELIGION^ ANCESTRY^ and/or ORIGIN^ GENDER^ and/or GENDER IDENTITY AND EXPRESSION^ SEXUAL ORIENTATION^ MENTAL, PHYSICAL, OR SENSORY DISABILITY^ OTHER DISTINGUISHING CHARACTERISTICS^	1
Complete this section for HIB Confirmed Incidents only
30	Effect of HIB Incident	Indicates the effect of the incident on the victim and/or offender: Offender knew action would physically or emotionally cause harm to the victim or damage to the victim's property Victim was in fear of physical or emotional harm or damage to personal property Insulted or demeaned a student or a group of students Interfered with victim's education Created a hostile educational environment by severely or pervasively causing physical or emotional harm to the student	[Incident_LU_Code]Code_Type=attributecode [Incident_LU_Code]Incident_Category = HIB - EFFECT^ [Incident_LU_Sub_Code]Sub_Category = OFFENDER KNEW ACTION WOULD CAUSE HARM^ VICTIM IN FEAR OF HARM OR DAMAGE TO PROPERTY^ INSULTED OR DEMEANED STUDENT(S)^ INTERFERED WITH VICTIMS EDUCATION^ CREATED A HOSTILE EDUCATIONAL ENVIRONMENT^	1
31	Mode of HIB Incident	Indicates the offender's mode of harassment, intimidation, or bullying: Gesture Written Verbal Physical (major or minor injury) Electronic communication	[Incident_LU_Code]Code_Type=attributecode [Incident_LU_Code]Incident_Category = HIB - MODE^ [Incident_LU_Sub_Code]Sub_Category = GESTURE^ WRITTEN^ VERBAL^ PHYSICAL (MAJOR OR MINOR INJURY)^ ELECTRONIC COMMUNICATION^	10
32	Remedial action(s) for the Offender(s)	Indicates the remedial action(s) taken for the offender(s): Intervention and Referral Services Parent conference Peer support group Referral for therapy treatment Restorative practices Student counseling Other measures	[Incident_LU_Code]Code_Type=actioncode [Incident_LU_Code]Incident_Category = HIB OFFENDER - REMEDIAL ACTION^ INTERVENTION AND REFERRAL SERVICES^ PARENT CONFERENCE^ PEER SUPPORT GROUP^ REFERRAL FOR THERAPY/TREATMENT^ RESTORATIVE PRACTICES^ STUDENT COUNSELING^ OTHER MEASURES (SPECIFY)^	1
33	Remedial action(s) for the Victim(s)	Indicates the remedial action(s) taken for the victim(s): Intervention and Referral Services Parent conference Peer support group Referral for therapy treatment Restorative practices Student counseling Other measures	[Incident_LU_Code]Code_Type=actioncode [Incident_LU_Code]Incident_Category = HIB VICTIM - REMEDIAL ACTION^ INTERVENTION AND REFERRAL SERVICES^ PARENT CONFERENCE^ PEER SUPPORT GROUP^ REFERRAL FOR THERAPY/TREATMENT^ RESTORATIVE PRACTICES^ STUDENT COUNSELING^ OTHER MEASURES (SPECIFY)^	1
Complete Victim information for HIB Alleged and Confirmed incidents Note: A new victim record is reported in this section for each victim in the incident.
34	First Name	The victim's first name.	[PSRW_INCIDENTPARTICIPANT]First_Name	30
35	Last Name	The victim's last name.	[PSRW_INCIDENTPARTICIPANT]Last_Name	30
36	State NJ SMART Student ID (required)	The student's state-assigned ID number.	[Students]State_StudentNumber	10
37	Gender	Indicates the student's gender: Male Female	[Students]Gender	1
38	Race/Ethnicity	Indicates the offender's race/ethnicity: Hispanic or Latino of any race Asian Black or African American White American Indian, Alaskan Native Native Hawaiian or Other Pacific Islander Two or more races	[Students]FedEthnicity [Students]Ethnicity	1
39	LEP	Indicates whether the student has limited English proficiency status.	[S_NJ_STU_X]LEP_TF	1
40	Disability Status	Indicates the student's disability status: Yes (IDEA) Yes (504 only) No	if [S_NJ_STU_X]SpecialEd_Classification is not blank and not ('PSD','SM','99') if [S_NJ_STU_X]PID_504_TF = 1 if neither of the above is true	1

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