Incident Report Form
If you feel you or someone else's safety is at risk and you need immediate action please call the local police or 911.
Building Level
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Definitions
Prior to completing this form please consider the following definitions of conflict and bullying.

Conflict is characterized by the fact that it generally happens in the heat of the moment. It is often a difference of opinion and most of the time both parties involved are equally upset. It is not something that happens all the time nor is it planned, it tends to be just every now and then and most of the time those involved want to see it sorted out and those involved equally have the power to change the situation.

Bullying is more of a deliberate act and there is the intention to hurt, insult or threaten the other person. In the case of bullying there is a definite power imbalance where the bully seeks to manipulate the situation so that the target has no power. This makes it very difficult for the student being bullied. They want to see the bullying stopped; however, often there is no willingness on the bully’s side to change. Bullying is usually a repeated activity. Life can often become worse for the target as the bullying continues.

Today's Date
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Your Name
Your answer
Contact Information (Phone and/or E-Mail)
Your answer
What type of incident is this?
Has this incident happened before?
Incident Date
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Incident Time
Time
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Name of Person(s) Involved
Your answer
Describe the Incident
Please provide as much detail as possible
Your answer
Location of Incident
Where did this happen?
Your answer
Where there any witnesses to this incident? If so, please list names.
Your answer
Was this incident reported to a faculty member in a different fashion?
If yes, please answer the following question. If no, click the Submit button
To whom and when was the incident reported?
Your answer
How would you like us to follow-up?
Your answer
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