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REMS 000053 0002 (U.S. Department of Education)

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Adapted from Guidelines for Responding to Student Threats of Violence by Dewey Cornell and Peter Sheras, (Sopris West, 2006)
* Prior to releasing these documents to parents/guardians, all identifying information relating to other students shall be
redacted
SS/SE-233 (5/08)
1
FCPS Threat Assessment Documentation Date:
Instructions: This form should be completed by the school administrator when conducting a threat assessment. This form should be
maintained in the cumulative file of the student’s scholastic record if the threat is determined to be substantive. If the threat is
determined to be transient, the form may be maintained in the student’s scholastic record at the discretion of the administrator. Record
specific account(s) of the threat made from the student making the threat and from the recipient(s) of the threat and witness(s) as
applicable.
Administrator completing form: Position:
School:
Information on student making threat:
Name of student Date of birth Grade
Address Home phone
Emergency contact Relationship
Is there a history of violent behavior in school? Yes No Unknown
Is there a history of violent behavior away from school? Yes No Unknown
Is there a history of discipline referrals? Yes No Unknown
Other information:
Information about the threat:
Date threat occurred: ____/____/_____ Date administrator learned of threat: ___/____/_____
Where the threat was made:
Who reported the threat:
What was reported (quote as possible; use quotation marks to identify direct quotes)
Information on victim(s) or recipient(s) of threat:
Has the intended target/victim(s) been identified? Yes No
Name(s) & grade of victim(s):
Primary recipient(s) of the threat (check all that apply):
Student Teacher Parent Administrator Other
Number of victim/recipients of threat: one two three four five or more
Adapted from Guidelines for Responding to Student Threats of Violence by Dewey Cornell and Peter Sheras, (Sopris West, 2006)
* Prior to releasing these documents to parents/guardians, all identifying information relating to other students shall be
redacted
SS/SE-233 (5/08)
2
FCPS Threat Assessment Documentation Date:
Student Name: Administrator completing interview:
Student Interview Directions: Use these questions as a guide to interview the student making the threat.
Other questions should be asked, if appropriate and relevant. This should not be completed by the student.
Use quotation marks to indicate student’s exact words when applicable.
1. Do you know why I wanted to talk with you? Tell me.
2. What happened today when you were [place of incident]? (record student’s exact words as possible)
3. What exactly did you say? And what exactly did you do?
4. What did you mean when you said or did that?
5. How do you think [person who was threatened] feels about what you said or did? (Probe to see if the
student believes the person who was threatened was frightened or intimidated.)
6. What was the reason you said or did that? (Probe to find out if there is a prior conflict or history to this
threat.)
7. What are you going to do now? Do you intend to carry out the threat?
8. Additional witnesses; Other relevant information:
Adapted from Guidelines for Responding to Student Threats of Violence by Dewey Cornell and Peter Sheras, (Sopris West, 2006)
* Prior to releasing these documents to parents/guardians, all identifying information relating to other students shall be
redacted
SS/SE-233 (5/08)
3
FCPS Threat Assessment Documentation Date:
Witness Name: Administrator completing interview:
Witness Interview Directions: Use these questions as a guide for individuals who have direct or indirect
knowledge of the threat; complete this form for each individual interviewed. Other questions should be asked,
if appropriate and relevant. This should not be completed by the student. Write the student’s exact words as
possible and use quotation marks to indicate student’s exact words.
Is the witness the Recipient (target) of threat or Witness to threat, but not recipient
If the witness is the recipient are they a student or staff member
Has the recipient been threatened before by this individual Yes No
1. What exactly happened today when you were [place of incident]?
2. What exactly did [student who made the threat] say or do? (Write the witness’s exact word.)
3. What do you think he or she meant when saying or doing that?
4. How do you feel about what he or she said or did? (Gauge whether the person who observed or received
the threat feels frightened or intimidated.) Are you concerned that he or she might actually do it?
5. Why did he or she say or do that? (Find out whether witness knows of any prior conflict or history behind
this threat.)
6. Additional witnesses; Other relevant information:
Adapted from Guidelines for Responding to Student Threats of Violence by Dewey Cornell and Peter Sheras, (Sopris West, 2006) –
* Prior to releasing these documents to parents/guardians, all identifying information relating to other students shall be
redacted
4
Fairfax County Public Schools
Threat Assessment and Response Summary Sheet
This summary sheet is used to determine the level of threat and to guide the response to the threat.
Name of student: Date of threat:
Team members:
To your knowledge did the student making the threat:
Have or seek accomplices: Yes No Unknown
Report the threat as a specific plan: Yes No Unknown
Write plan(s) or a list: Yes No Unknown
Repeat the threat over time: Yes No Unknown
Mention weapon in the threat: Yes No Unknown
Use weapon in the threat: Yes No Unknown
Have prior conflict with recipient: Yes No Unknown
Previously threaten the recipient: Yes No Unknown
Experience being bullied by the recipient of the threat: Yes No Unknown
Follow or approach the recipient of the threat: Yes No Unknown
Have the ability to develop and carry out the threat: Yes No Unknown
Based on the interviews and the responses above, determine the type of threat (refer to FCPS Threat Assessment Guidelines as
necessary). Check appropriate box and once identified, follow the prescribed response.
Transient Serious Substantive Very serious Substantive
RESPOND TO TRANSIENT THREAT RESPOND TO SERIOUS THREAT RESPOND TO VERY SERIOUS THREAT
Contact student’s parents if necessary
Notify intended victim’s parents if
necessary
See that threat is resolved through
explanation, apology or making amends
Consult with safety and security
specialist/SRO if necessary
Refer for conflict mediation or
counseling, to resolve problem if
appropriate
Follow discipline procedures as per
Regulation 2601
Develop Behavior Intervention Plan/
contract as appropriate
Maintain threat assessment
documentation in the cumulative file of
the student’s scholastic record, if
completed, as appropriate
Mobilize threat assessment team
members as needed
Notify student’s parents
Protect and notify intended victim
and parents of victim
Caution the student about the
consequences of carrying out the
threat
Provide direct supervision of student
until parents assume control
Consult with safety and security
specialist/SRO
Refer for conflict resolution or
counseling
Follow discipline procedures as per
Regulation 2601
Develop Behavior Intervention Plan
Maintain threat assessment
documentation in the cumulative file
of the student’s scholastic record
Mobilize threat assessment team
Notify student’s parents
Protect and notify intended victim and
parents of victim
Notify cluster assistant superintendent or
designee
Caution the student about the
consequences of carrying out the threat
Provide direct supervision of student
until parents assume control
Consult with safety and security
specialist/police
Follow discipline procedures as per
Regulation 2601
Conduct mental health assessment
Develop Behavior Intervention
Plan/contract
Maintain threat assessment
documentation in the cumulative file of
the student’ scholastic record
Print name of administrator: ____________________________________ Date: ______________________
Signature of administrator: ___________________________________________________________________
(signature indicates agreement with identified level of threat indicated above)
SS/SE-233 (5/08)
FCPS THREAT ASSESSMENT AND RESPONSE PROTOCOL
Adapted from the Guidelines for Responding to Student Threats of Violence, Virginia Youth Violence Project (Cornell & Sheras, 2006)
IDENTIFY AND EVALUATE THREAT
A threat is an expression of intent to harm someone that may be spoken, written, or gestured. An expression of intent to harm someone is considered
a threat regardless of whether it is communicated to an actual or prospective victim and regardless of whether the actual or prospective victim is
aware thereof, existing in any fashion, whether orally, visually, in writing, or electronically. This protocol does NOT address threats to damage
property, threats made by non-students, fights with no threat, or language such as slurs, insults, or verbal abuse that does not constitute a threat.
WHEN IN DOUBT, treat the expression as a threat. See Regulation 2111 for more specific guidance.
Student threats shall be reported to the school administrator (principal, assistant principal, or principal designee) if they cannot be easily and readily
resolved by other staff. Criteria for reporting threats should include age of the child, and the context of the threat or remark.
The administrator makes a preliminary determination of the seriousness of the threat. If the threat has not been resolved, and the administrator
determines it is potentially serious, then the Threat Assessment Documentation and Threat Assessment and Response Summary Sheet should be
completed.
The student, recipients of threat, and other witnesses shall be interviewed to obtain a specific account of threat in context using the Threat Assessment
Documentation form.
Student Interview
• Do you know why I wanted to talk with you?
• What happened when you were [place of incident]?
• What exactly did you say? And what exactly did you do?
• What did you mean when you said or did that?
• How do you think he/she feels about what you said or did?
• What was the reason you said or did that?
• What are you going to do now that you have made this threat?
Witness Interview
• What exactly happened when you were [place of incident]?
• What exactly did [student] say or do?
• What do you think he/she meant when saying that?
• How do you feel about what he/she said or did?
• Why did he/she say or do that?
DETERMINE WHETHER THREAT IS CLEARLY TRANSIENT OR SUBSTANTIVE
Substantive Threat
A substantive threat meets one or more of the following:
• Specific, plausible details such as a specific victim, time, place, and method
• Threat has been repeated over time or related to multiple persons
• Threat is reported as a plan or planning has taken place
• Recruitment of accomplices or invitation for an audience
• Physical evidence of intent to carry out threat (e.g., lists, drawings, written plan)
Factors to consider in which substantive threats are more likely:
Age of student Credibility of account Documented history of aggression
DETERMINE IF SUBSTANTIVE THREAT IS SERIOUS OR VERY SERIOUS
Transient Threat
A transient threat meets one or more of the
following:
• Non-genuine expression
• Non-sustainable intent to harm
• Temporary feelings of anger
• Tactic in argument
• Intended as joke or figure of speech
• Resolved on scene or office (time-limited)
• Conflict is resolved and ends with apology,
retraction, or clarification
• WHEN IN DOUBT, consider threat as
substantive and assess further
Serious
A threat to assault
Very Serious
Threat to kill, rape, or inflict severe injury or involves
the use of weapons
RESPOND TO TRANSIENT THREAT RESPOND TO SERIOUS THREAT RESPOND TO VERY SERIOUS THREAT
Contact student’s parents if necessary
Notify intended victim’s parents if
necessary
See that threat is resolved through
explanation, apology or making amends
Consult with safety and security
specialist/SRO if necessary
Refer for conflict mediation or counseling,
to resolve problem if appropriate
Follow discipline procedures as per
Regulation 2601
Develop Behavior Intervention Plan
/behavior contract as appropriate
Maintain threat assessment documentation
in the cumulative file of the student’s
scholastic record, if completed, as
appropriate
Mobilize threat assessment team
members as needed
Notify student’s parents
Protect and notify intended victim and
parents of victim
Caution the student about the
consequences of carrying out the threat
Provide direct supervision of student
until parents assume control
Consult with safety and security
specialist/SRO
Refer for conflict resolution or
counseling
Follow discipline procedures as per
Regulation 2601
Develop Behavior Intervention
Plan/behavior contract
Maintain threat assessment
documentation in the cumulative file of
the student’s scholastic record
Mobilize threat assessment team
Notify student’s parents
Protect and notify intended victim and
parents of victim
Notify cluster assistant superintendent or
designee
Caution the student about the
consequences of carrying out the threat
Provide direct supervision of student until
parents assume control
Consult with safety and security
specialist/police
Follow discipline procedures as per
Regulation 2601
Conduct mental health assessment
Develop Behavior Intervention
Plan/behavior contract
Maintain threat assessment documentation
in the cumulative file of the student’s
scholastic record
5
Adapted from Guidelines for Responding to Student Threats of Violence by Dewey Cornell and Peter Sheras, (Sopris West, 2006)
* Prior to releasing these documents to parents/guardians, all identifying information relating to other students shall be redacted
SS/SE-233 (5/08)
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Completed 30 June 2021

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