Brevard Public Schools
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Forms and Procedures

These forms are available for printing purposes.  You must print the forms, fill them out, and then return to the appropriate individual.  Most forms are in .pdf format.  You must have the .pdf free reader installed on your computer.

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Administration Support Staff Property
Program Students Operations
Instructional Staff Finances Community Relations
Human Resources Building Department  
Name PDF Size Procedure Number
ADMINISTRATION
Authorization for Release of Health Information 45 K Available 1420df3
Bullying, Sexual Harassment, Other Forms of Harassment, and Teen Dating Violence and Abuse Policy Forms      
Certification to Group Health Plan 37 K Available 1420df1b
Employee/Applicant Harassment Grievance Form Under Provisions of Board Policy Step 2 49 K Available 1362f1
Employee/Applicant Harassment Grievance Form Under Provisions of Board Policy Step 3 49 K Available 1362f2
Employee Confidentiality Agreement 32 K Available 1420df2
Ethics Complaint Form 48 K Available 1210f1
Ethics Pledge 9 K Available 1210f2
Exit Interview (protected WORD doc)
Exit Interview (PDF)
70 K
27 K
   
Exit Student Survey 32 K    
Group Health Plan's Response to Amendment or Correction Request 48 K Available 1420df7
Group Health Plan's Response to Inspection Request 47 K Available 1420df5
Harassment Accused Interview 65 K Available 1362f4
Harassment Complainant/Accused's Supervisor Interview 59 K Available 1362f6
Harassment Complainant Interview 85 K Available 1362f3
Harassment Witness Interview 52 K Available 1362f5
Individual Request Not to Use or Disclose Health Information 58 K Available 1420df4
Individual Request to Correct or Amend a Record 45 K Available 1420df6
Notice of Privacy Practices 107 K Available 1420df1
Notification of Acceptance of a Gift with a Value In Excess of $50.00 36 K Available 1210f3
Parent Notification of Intent to Terminate School Enrollment 36 K    
Privacy Notice for SPD's 31 K Available 1420df1a
Request for Transfer of Family Member Sick Leave 49 K Available 1420f1
Social Media Guidelines Acknowledgement Form 76 K    
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Name PDF Size Procedure Number
PROGRAM
Applicant Identification Form 45 K Available 2605f1
Assurances Form 46 K Available 2605f3
Evacuation Procedures for Activity Trips and Field Trips 36 K Available 2340f5a
Parent Permission and Responsibility Statement for Off-Campus Activity 64 K Available 2340f2
Request to Inspect Materials Used in Conjunction with Any Survey, Analysis, or Evaluation 34 K Available 2416f2
Requisition for Special School Bus Transportation 62 K Available 2340f5
Research Project Action Form 66 K Available 2605f4
Research Review Form 85 K Available 2605f2
Responsibilities of Trip Chaperones 35 K Available 2340f7
Sponsor's Application for Permission to Plan an Off-Campus Field Trip/Activity 58 K Available 2340f1
Statement of Insurance on Private Vehicles 75 K Available 2340f6
Student Medical Release Form for Out-of-County or Overnight Travel 56 K Available 2340f3
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Name PDF Size Procedure Number
INSTRUCTIONAL STAFF
Authorization for Release of Health Information 45 K Available 3420df3
Certification to Group Health Plan 37 K Available 3420df1b
Community Resources 103 K    
Employee/Applicant Harassment Grievance Form Under Provisions of Board Policy Step 2 49 K Available 3362f1
Employee/Applicant Harassment Grievance Form Under Provisions of Board Policy Step 3 49 K Available 3362f2
Employee Confidentiality Agreement 32 K Available 3420df2
ESOL Out-of-Field Approval Request Form and Parent Notification Letter      
Ethics Complaint Form 48 K Available 3210f1
Ethics Pledge 9 K Available 3210f2
Exit Interview (protected WORD doc)
Exit Interview (PDF)
70 K
27 K
   
Exit Student Survey 32 K    
Group Health Plan's Response to Amendment or Correction Request 48 K Available 3420df7
Group Health Plan's Response to Inspection Request 47 K Available 3420df5
Harassment Accused Interview 65 K Available 3362f4
Harassment Complainant/Accused's Supervisor Interview 59 K Available 3362f6
Harassment Complainant Interview 85 K Available 3362f3
Harassment Witness Interview 52 K Available 3362f5
Homeless - Best Practices in Homeless Education (Determining Eligibility) 73 K    
Homeless - Caregiver Authorization Form 228 K    
Homeless - Casework Referral 108 K    
Homeless - Data Input for Students Identified as Homeless 124 K    
Homeless - Enrollment Procedures & Services 73 K    
Homeless - Expenditure Request Form 73 K    
Homeless - Field Trip Payment Application 73 K    
Homeless - Homeless Students Report 93 K    
Homeless - Release-1H Release & Exchange of Information 13 K    
Homeless - Students-In-Transition:  Procedures (Flowchart) 79 K    
Homeless - Transportation Request 61 K    
Homeless - Tutoring/School Supply Request 129 K    
Individual Request Not to Use or Disclose Health Information 58 K Available 3420df4
Notice of Privacy Practices 107 K Available 3420df1
Notification of Acceptance of a Gift with a Value In Excess of $50.00 36 K Available 3210f3
Parent Notification of Intent to Terminate School Enrollment 36 K    
Privacy Notice for SPD's 49 K Available 3420df1a
Request for Transfer of Family Member Sick Leave 49 K Available 3420f1
Individual Request to Correct or Amend a Record 45 K Available 3420df6
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Name PDF Size Procedure Number
SUPPORT STAFF
Authorization for Release of Health Information 45 K Available 4420df3
Certification to Group Health Plan 37 K Available 4420df1b
Community Resources 103 K    
Employee/Applicant Harassment Grievance Form Under Provisions of Board Policy Step 2 49 K Available 4362f1
Employee/Applicant Harassment Grievance Form Under Provisions of Board Policy Step 3 49 K Available 4362f2
Employee Confidentiality Agreement 31 K Available 4420df2
Ethics Complaint Form 49 K Available 4210f1
Ethics Pledge 9 K Available 4210f2
Group Health Plan's Response to Amendment or Correction Request 48 K Available 4420df7
Group Health Plan's Response to Inspection Request 47 K Available 4420df5
Harassment Accused Interview 65 K Available 4362f4
Harassment Complainant/Accused's Supervisor Interview 59 K Available 4362f6
Harassment Complainant Interview 85 K Available 4362f3
Harassment Witness Interview 52 K Available 4362f5
Homeless - Best Practices in Homeless Education (Determining Eligibility) 73 K    
Homeless - Caregiver Authorization Form 228 K    
Homeless - Casework Referral 108 K    
Homeless - Data Input for Students Identified as Homeless 124 K    
Homeless - Enrollment Procedures & Services 73 K    
Homeless - Expenditure Request Form 73 K    
Homeless - Field Trip Payment Application 73 K    
Homeless - Homeless Students Report 93 K    
Homeless - Release-1H Release & Exchange of Information 13 K    
Homeless - Students-In-Transition:  Procedures (Flowchart) 79 K    
Homeless - Transportation Request 61 K    
Homeless - Tutoring/School Supply Request 129 K    
Individual Request Not to Use or Disclose Health Information 57 K Available 4420df4
Individual Request to Correct or Amend a Record 45 K Available 4420df6
Notice of Privacy Practices 107 K Available 4420df1
Notification of Acceptance of a Gift with a Value In Excess of $50.00 36 K Available 4210f3
Privacy Notice for SPD's 30 K Available 4420df1a
Request for Transfer of Family Member Sick Leave 49 K Available 4420f1
Staff Network and Internet Acceptable Use and Safety Agreement   Available 7540.04f1
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Name PDF Size Procedure Number
STUDENTS
Cloud Collaboration Permission Slip Elementary 39 K    
Cloud Collaboration Permission Slip Secondary 40 K    
Community Resources 103 K    
Directory and Photographs/Videos - Opt Out Form 276 K    
Elementary Grades 1-6 Student Attendance Appeal Packet 8 K Available 5200f3
Ethnicity Form - English      
Ethnicity Form - Spanish      
Field Trip Manual/Forms 341 K    
Home Education Change of Address Form      
Home Education Notice of Intent - fill able
Home Education Notice of Intent - print copy
88 K Handbook  
Home Education Request for Duplicate of Verification Letter 62 K Handbook  
Home Education Sample EL7 Form      
Home Education-Termination Notice - fill able
Home Education-Termination Notice - print copy
61K
39 K
Handbook  
Home Education Written Evaluation - fill able
Home Education Written Evaluation - print copy
79 K Handbook  
Homeless Addendum 21 K    
Homeless - Best Practices in Homeless Education (Determining Eligibility) 73 K    
Homeless - Caregiver Authorization Form 228 K    
Homeless - Casework Referral 108 K    
Homeless - Data Input for Students Identified as Homeless 124 K    
Homeless - Enrollment Procedures & Services 73 K    
Homeless - Expenditure Request Form 73 K    
Homeless - Field Trip Payment Application 73 K    
Homeless - Homeless Students Report 93 K    
Homeless - Release-1H Release & Exchange of Information 13 K    
Homeless - Students-In-Transition:  Procedures (Flowchart) 79 K    
Homeless - Transportation Request 61 K    
Homeless - Tutoring/School Supply Request 129 K    
Kindergarten Student Attendance Appeal Packet 8 K Available 5200f2
Parent Statement Page 4 K Available 5200f1
Registration Forms/Website      
Request for Out of Area Assignment (K-12)
Request for Out-of-Area Assignment Guidelines
     
Secondary Student Attendance Appeal Packet 8 K Available 5200af1
Secondary Course Form 6 K Available 5200af2
Secondary Student Statement Page 5 K Available 5200af3
Student Internet Acceptable Use - Opt Out   Available 7540.03f1
Student Reporting Form      
Transcript Request Form      
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Name PDF Size Procedure Number
FINANCES
Automatic Bank Deposit Authorization 19 K    
Contracted Services Agreement 84 K   6540f1
In County/Out of County Travel Expense Reports      
Payroll Reduction Authorization for 403(b) Annuity 32 K    
Payroll Reduction Authorization  for 457(b) 32 K    
Duplicate W-2 111 K    
W-4 Form 237 K    
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Name PDF Size Procedure Number
PROPERTY
Building Use Set-Up Form 50 K    
Computer Incident Reporting Form 66 K Available 7540.09f1
Confidentiality Agreement 13 K    
(17) Crime or Violence Situation - Incident - Criminal Mischief (Vandalism) 45 K Available 7440.02f1
(40) Facility Emergencies - Doors that won't Lock/Re-Keying Doors 65 K Available 7440af4
(33) Facility Emergencies - Major Fire/Explosion 72 K Available 7440af2
(34) Facility Emergencies - Small Fire 68 K Available 7440af3
(41) Facility Emergencies - Structural Failure/Building Collapse 70 K Available 7440af5
First-Step Software Evaluation Considerations 103 K Available 7540gf1
Mobile Computing Device Assignment and Use Agreement Form 53 K Available 7540.08f1
Network Change Management Request Form 57 K Available 7540if1
Permission to Copy District Owned Software 36 K Available 7540.01f2
Permission to Use/Import Software 35 K Available 7540.01f1
Property Loan Form 103 K    
Remote Connectivity Access Form 53 K Available 7540kf1
Request for Wireless Connectivity 52 K Available 7540nf1
(32) Shelter in Place/Evacuation - Evacuation 65 K Available 7440f1
(46) Unique Incidents & Severe Weather - Flooding 69 K Available 7440af9
(45) Unique Incidents & Severe Weather - Hurricane 72 K Available 7440af8
(44) Unique Incidents and Severe Weather - Tornado or Severe Storms 72 K Available 7440af7
(43) Unique Situations - Incident - Airplane Crash on or near Campus 59 K Available 7440af6
(28) Weapon Situation - Incident - Discharge of Firearm 56 K Available 7217f4
(29) Weapon Situation - Incident - Displayed Knife 51 K Available 7217f5
(24) Weapon Situation - Incident - Found Bullet or Other Unusual and Dangerous Object 50 K Available 7217f1
(27) Weapon Situation - Incident - Student/Employee with a Gun - Concealed 57 K Available 7217f3
(26) Weapon Situation - Incident - Student/Employee with a Gun - Displayed 61 K Available 7217f2
(30) Weapon Situation - Incident - Student with Knife Concealed 52 K Available 7217f6
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Name PDF Size Procedure Number
OPERATIONS
Access to Employee Exposure and Medical Records 100 K    
Addendum to Clean Campus Report EH&S 14 K    
Asbestos Specification Document 299 K    
"Bio Medical Waste Training Acknowledgement"      
Bloodborne Pathogens and Hazard Communication Group Training Acknowledgement Form      
Confined Space Assessment 67 K    
Daily Playground Inspection Checklist 75 K    
Egress/Relocation Drill Form 60 K    
Electronic Submittal Form for the Egress/Relocation Drill      
Emergency Contact Form      
Emergency Telephone Numbers 86 K    
Evidence of CPR and AED Training 44 K Available 8452f1
Fall Protection Plan Checklist 118 K    
Forklift/Motorized Hand Truck Daily Inspection Report 77 K    
Hazard Exposure Control and Biomedical Waste Plan Form      
Hazardous Materials Inventory List (Blank) 405 K    
Hazard Recognition Form 86 K    
Hepatitis B Vaccine - Acceptance 78 K    
Hepatitis B Vaccine - Declination Statement 59 K    
Initial Playground Safety Audit Form 154 K    
Job Hazard Analysis Form 41 K    
Laboratory Safety Checklist 70 K    
Lockout/Tagout Initial Survey 65 K    
Lockout/Tagout Observation Form 84 K    
Lockout/Tagout Procedure Form 90 K    
Monthly Inspection Checklist 119 K    
Non-Permit Confined Space Reclassification Certification 89 K    
Permit-Required Confined Space Entry Permit 87 K    
Personal Protective Equipment Survey and Assessment 69 K    
Playground Equipment Procurement and Installation Approval Form 25 K    
Respirator Program Evaluation Form 103 K    
Risk Management Reporting Form 38 K    
Safe Driver Plan - Acknowledgement of Receipt of Safe Driver Plan 35 K Available 8600f2
Safe Driver Plan - Assessment of Points 56 K Available 8600f1
Safety Committee Recommendations 84 K    
(87) Support Appendix: Sexual Offender/Sexual Predator - Community Notification 77 K Available 8470f1
Waste Identification & Removal Form 8 K    
Water Outage Guidelines 28 K    
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Name PDF Size Procedure Number
COMMUNITY RELATIONS
Request for Public Records 21 K    
TOP
Name PDF Size Procedure Number
Human Resources
Change of Address      
Days of Service - Admin/Prof/Instructional      
Days of Service -  Support      
Days of Service - Year Round Schools      
Ethics Complaint Form 48 K Available 1210f1
Ethics Pledge 9 K Available 1210f2
Leave of Absence      
Resignation Form 2.51 MB    
Vacancy/Position Control      
TOP
Name PDF Size Procedure Number
Building Permit Application
Permit Application (PDF) 372 K    
Instructions for Permit Applications 91 K    
Insurance Requirements 74 K    
TOP
Name PDF Size Procedure Number
School-Initiated Projects
Agreement for School Initiated Projects 318 K    
Instructions and Procedures for School Initiated Projects 79 K    
Insurance Requirements & Hold Harmless Agreement 18 K    
TOP

 

 

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Brevard Public Schools
2700 Judge Fran Jamieson Way
Viera, FL 32940     321-633-1000 ext. 500

Ethics Hotline    321-633-1000 ext. 170

The School Board of Brevard County is an
Equal Opportunity Employer



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