FOLIO:

PROTOCOLO DE AGRESIÓN ESTUDIANTE – PROFESOR/A

1) Identificación de quién activa el presente protocolo:

DIRECTOR/A

ENCARGADO/A CONVIVENCIA ESCOLAR

OTRO MIEMBRO DE LA COMUNIDAD ESCOLAR

2) Recibir relato, denuncia o declarar situación vista o identificada.

Nombre persona adulta o estudiante (y curso) cuyo relato se toma o de quien declara:

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Fecha:

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Firma:

3) Medidas de resguardo a adoptar con el sólo relato de las partes intervinientes:

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4) Declaración de otros intervinientes o de testigos. Especificar nombre de quien declara y de quien

toma la declaración, si es alguien distinto a quien activa el protocolo.

Nombre: Fecha:

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Firma:

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Nombre: Fecha:

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Firma:

Nombre: Fecha:

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5) Entrevista con apoderado o apoderados, ya sea del estudiante víctima o del presunto agresor.
Señalar fecha, y si se hace en un documento aparte, señalar nombre apoderado, nombre pupilo,
nombre de quien toma la entrevista, y firma de los intervinientes. Corchetear dicha acta de entrevista
al presente documento de protocolo si está en un documento aparte.

Nombre apoderado: Fecha:

Nombre estudiante:

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Firma:

Nombre apoderado: Fecha:

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6) Indicación de otros antecedentes o medios de prueba recopilados:

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 INFORME FINAL (O INFORME DE CIERRE) DEL PROTOCOLO

i. Nombre de la persona que confecciona el informe final:

ii. Fecha de informe final:

iii. Lista personas entrevistadas:

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iv. Lista otros medios de prueba recopilados:

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v. Conclusión informe: ¿Se pudo comprobar los hechos denunciados a partir de la evidencia
recopilada? Marque con una cruz.

SI NO

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 vi. Indicar qué medida de apoyo pedagógico se adoptará, si procede, de acuerdo con las indicadas
en el Reglamento Interno:
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vii. Indicar si se abrirá procedimiento sancionatorio o no, dependiendo de si se configuró una falta:

SI NO

Si la respuesta fue SI, proceder al formulario correspondiente en materia de PROCEDIMIENTO

SANCIONATORIO, y realizar las notificaciones relativas al mismo.

A modo de referencia para el procedimiento sancionatorio, dejar constancia de:

- Tipo de falta: ____________________________________________________________

- Existencia de atenuantes: __________________________________________________
- Existencia de agravantes: __________________________________________________
- Posible medida disciplinaria o sanción: ________________________________________

PASO FINAL:

Citar a apoderados/as de los/las estudiantes intervinientes, por separado, y relatarles lo realizado y las
conclusiones. Entregarle una copia del protocolo activado.

Nombre apoderado: Fecha:

Nombre estudiante:

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Firma:

Nombre apoderado: Fecha:

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Firma:

NOMBRE Y FIRMA CIERRE PERSONA QUE CONFECCIONÓ EL PROTOCOLO:

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