San Bernardino City Unified School District
San Bernardino City Unified School District
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Student/Visitor Injury Reporting

When a student or a visitor is injured at your site, a Student/Visitor Injury Repot (RM-2) must be completed. This form may be completed by any responsible employee who witnesses the injury/allergic reaction or assisted with the first aid or the administration of EpiPen medication. The Student/Visitor Injury Report can be found attached to this bulletin, or on the District’s Safety Webpage. Submit forms to the Safety/Emergency Management Office via email to , or faxed at (909)381-6215. Each site should keep a copy of the report.

Complete the STUDENT/VISITOR INCIDENT REPORT for all incidents of:

  1. Injury of any significance
  2. Use of EpiPen for allergic reaction
  3. Injury resulting from confrontation between two more persons; unless reported to Police.
  4. Any questionable incident that should be reported and documented.

The Student/Visitor Injury Report is a confidential, internal document. Its contents are not to be shared, copied or distributed to any persons. Should a copy of a specific incident be requested, please refer them to the Safety/Emergency Management Office at (909)381-1193.

Thank you for your cooperation and attention in this matter.

DOWNLOAD the Student Visitor Incident Report Form (RM-2).


San Bernardino City Unified School District, 777 North F Street, San Bernardino, CA 92410, (909) 381-1100
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