Abuse of Students by School District Employees
Level I Investigation Report
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 leave
student assigned to different class other (please specify)
Level I investigator’s conclusions:
The complaint is being dismissed for lack of jurisdiction.
if true, would not meet the definition of sexual abuse in the rules.
sponsored activity, nor in a school-related context.
The complaint has been investigated and concluded at Level I as unfounded.
took place.
The complaint has been investigated at Level I and is founded.
further investigation.
enforcement at this time.
Current status of investigation:
matter.
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: November 17, 1997
Revised/Reviewed: January 24, 2022