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:
MM
/
DD
/
YYYY
Location:
If the location is elsewhere or online please give details:
Your answer
Please describe, in as much detail as possible, what you saw and heard:
Your answer
Were there any bystanders or witnesses?
Please identify if you witnessed this behavior as a bystander OR if you were the target (victim).
What is the victim's name?
Your answer
Gender:
Grade:
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