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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?
Clear selection
If this did not happen at school, where did the incident occur?
If this incident did occur at school- what was the location?
Clear selection
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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