Anonymous Incident Report

This electronic form is a place for you to report ANONYMOUSLY any incidents that take place in school, online or through texting.
(An incident may occur when one or more people repeatedly harm, harass, intimidate or exclude others either face-to-face, online or texting).

* All questions with asterisks must be completed.

Date:

YYYY

Location: *

Placentino

Miller

School Bus

Other:

If the location is elsewhere or online please give details:

Please describe, in as much detail as possible, what you saw and heard: *

Were there any bystanders or witnesses? *

Yes

Not sure/don't know

Please identify if you witnessed this behavior as a bystander OR if you were the target (victim). *

Bystander

Victim

Neither, I heard about it from someone else.

What is the victim's name? *

Gender: *

Male

Female

Grade. *

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