Fillable 1380 East Sixth Street Cleveland, Ohio 44114 Phone (Cleveland Metropolitan School District)

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1380 East Sixth Street Cleveland, Ohio 44114 Phone (Cleveland Metropolitan School District)

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1380 East Sixth Street
Room 106A
Cleveland, Ohio 44114
Phone (216) 574-8552
Fax (216) 574-8555
Request for Information Retrieved/Archived via Video Monitoring
Date: ________________________________ Incident Number: _____________________
Person(s) making request: ____________________________________________________
School: _____________________________________ Phone: _________________________
(department- if applicable)
Purpose of Archive Retrieval: __________________________________________________
Agent authorizing Archival Release: __________________________ Date: ____________
(Executive Director of Safety and Security)
Address of occurrence: ________________________________________________________
Exact location of alleged incident: ______________________________________________
____________________________________________________________________________
Type of incident (Damage to Property, Theft, Physical Disruption, etc.) ______________
____________________________________________________________________________
Date(s) of occurrence: ________________________ ______________________
Time(s) of occurrence: ________________________ ______________________
Description of person/object sought: ________________________________________
____________________________________________________________________________
Describe injury to person to be observed: ________________________________________
Describe damage to property to be observed: __________________________________
Explain what occurred: _______________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Archival analysis narration (official use only): ________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
By:______________________________________________ Date:_____________________
Camera retrievals effective in review analysis:
yes no not applicable
Results of findings tend to: support claim disprove claim appear inconclusive
Disposition of retrieved archival footage: ________________________________________
Archive Receipt: ____
______________________________ Date:_____________________
"The primary goal of the Cleveland Metropolitan School District is to become a premier school district in the United States of America"
"La meta primordial del Distrito Escolar Metropolitan de Cleveland es lograr ser un distrito escolar de primera clase en los Estados Unidos de America"
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1380 East Sixth Street Cleveland, Ohio 44114 Phone (Cleveland Metropolitan School District)

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Completed 14 June 2021

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