Bullying Incident Report Sheet
This form will immediately alert WIHI staff to incidents of bullying in the WIHI community. Please give as much information as you are comfortable sharing.
Name of Person Reporting Incident (CONFIDENTIAL)
Your name will NOT be revealed to any student, staff member unless you specifically ask for that as part of our response to the report. However, we require your full name as the reporting party to ensure that we can make an appropriate follow-up.
What was your Role During this Incident?
Witness (you saw the incident)
You learned of the incident from the victim or perpetrator (second-hand)
You learned of the incident from someone other than the victim or perpetrator (third-hand)
Name of Victim
Name/Names of Alleged Perpetrators
Description of Incident
Who should WIHI staff contact to ensure the issue has been resolved?
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