Delano Middle School Online Bullying Report Form
What is bullying? Bullying is when someone repeatedly and on purpose says or does mean or hurtful things to another person that may have a hard time defending himself or herself.
Your name *
Your answer
Your relationship to the person allegedly being bullied *
If reported to you by someone else, indicate who (first,last name) *
Your answer
Date of Incident *
Your answer
Type of Bullying *
Who was bullied? Please list first and last names of all students if more than one person was bullying *
Your answer
Who did the bullying? Please list first and last names of all students if more than one person was bullied. *
Your answer
Were there any by-standers/witnesses? Please list first and last names of all students if more than one person was witnessing the event(s). *
Your answer
Where did the bullying behavior occur? *
Specific location from above
Your answer
Time of Day? Add exact time below, if known. *
Exact time(s) of the day or class period *
Your answer
Has/Did this type or other types of bullying the the same persons (people) before?? Please explain below with dates/times etc. Is this the first time, second time or on-going type of bullying? For how long? *
Your answer
Briefly describe the incident. What did YOU actually see (witness) and/or hear? *
Your answer
Is there any other information that we need to know? *
Your answer
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