Potential Bullying Incident Report

Prior to completing this form please consider the following definitions of conflict and bullying. If you believe your concern is bullying, please continue with your report. If you believe it is conflict, please contact the building administrator directly. Thank you.

Conflict is characterized by interactions that generally happen in the heat of the moment. Conflict often arises from a difference of opinion and most of the time both parties involved are equally engaged and upset. As opposed to the chronic nature of bullying, conflict is neither planned nor ongoing; it tends to occur intermittently, and those involved have shared interest and ability to find resolution.

Bullying is a deliberate act in which there is the intention to cause fear, intimidate, hurt, or threaten the other person. In the case of bullying, there is a definite power imbalance where the bully seeks to manipulate the situation and leave the target powerless. This makes it extremely challenging for the student being bullied as they have a desire for the bullying to cease, however, there is no willingness on the bully’s side to terminate the behavior. Bullying is usually a repeated activity; however, it can also be a one-time incident. The behavior may be motivated by an actual or perceived distinguishing characteristic, such as, but not limited to: age; national origin; race; color; ethnicity; religion; gender; gender identity; sex; sexual orientation; physical attributes; physical or mental ability or disability; and social, economic or family status.


The School District of Whitefish Bay believes all should be treated with dignity and respect, and bullying behavior will not be tolerated. The purpose of this form is to collect specific information so that we may investigate allegations of bullying behavior.

Bullying encompasses unacceptable behavior as defined in the Board Policy 411.3 (http://www.boarddocs.com/wi/wfbschools/Board.nsf/goto?open&id=9YWW2C696AE1).

This report can be anonymous, so you are not required to include your name or the name of the victim if you choose not to. That being said having the ability to follow up for additional information may most likely assist in curbing undesired behavior.

Knowing the name of the alleged victim, reporter, or any witnesses, assists us in investigating the incident as thoroughly as possible so please include information as you feel comfortable. Disciplinary action will not be taken against an alleged aggressor solely on the basis of a report or allegation.

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    Thank you. Upon submittal this report will be forwarded to the building principal. The appropriate Pupil Service Staff will be contacted within 24 hours to begin the investigation. If you feel a student is in imminent danger please contact the building administrator immediately.

    FOR ADMINISTRATIVE USE ONLY

    Please file report in building of origin and forward a copy to Pupil Services Date Received: Signature of person who received report: Action Taken (Please attach documentation)