call 911 in case of an emergency

SUPPLEMENTAL-4

OPTIONAL for Monitoring

See Guide for detailed instructions

Wisconsin School Threat Assessment and Management Protocol (WSTAMP)

Plan To Protect Targeted Person

Person Name

Date of Incident

School

Plan Date

It was determined that the following Plan to Protect Targeted Person should be implemented based on concerning behavior.

The issues of concern are:

After meeting with Name, the Plan to Protect has been implemented.

Law Enforcement has been notified of this incident.

The parent/guardian of the above person was notified of this incident on (date):

Notification Date

The targeted person will aid in his/her own protection by:

Support from the school that will be provided:

Support from the outside agencies/providers that will be provided:

Support from home that will be provided:

Student Support Team:

Name

Title

Phone

Email

Name

Title

Phone

Email

Name

Title

Phone

Email

Name

Title

Phone

Email

Name

Title

Phone

Email