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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.
* Required
Date:
MM
/
DD
/
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
No
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.
*
Choose
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
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