| Problem Report
Filed by
__________________________________________________________
Date___________________
Who was involved?
_________________________________________________________________________
Where did it happen?
_______________________________________________________________________
When did it happen?
_______________________________________________________________________
Did anyone else see what happened?
__________________________________________________________
Tell what happened:
________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
How do you feel about what happened?
________________________________________________________
_________________________________________________________________________________________
How do you think the other person(s)
feel(s) about what happened? _________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Name 2 ways you could have solved the
problem: ________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
What could you have done so it would
not have happened at all? ____________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Solution Report
Filed by
__________________________________________________________
Date___________________
The Problem
______________________________________________________________________________
_________________________________________________________________________________________
My / Our Solution
__________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
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