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Bullying Incident Report for Temecula Valley Charter School
For students or parents. This report will be read by the administrator and/or designee. All reports will be investigated.
Date of incident
Time of incident: be as specific as you can be
Did this happen at school?
If this did not happen at school, where did the incident occur?
If this incident did occur at school- what was the location?
hallway or corridor
Describe the incident:
Name the victim(s).
Name the person(s) who were bullying.
Name the person(s) who were bystanders or witnesses.
Describe any physical injuries:
Please name all adults the incident was reported to:
Optional: your name
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This form was created inside of Temecula Valley Unified School District.