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Anonymous Bullying Incident Report Form
Use this form to safely and anonymously report bullying, harassment, or intimidation. Your identity will be protected.
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* Indicates required question
When did this happen?
*
MM
/
DD
/
YYYY
What time did the incident take place?
*
Your answer
Where did the incident take place?
*
Classroom
Hallway
Cafeteria
Gymnasium
Bus
School Playground
Online or Social Media
Other
Required
What type of behavior occurred?
*
Physical bullying
Verbal taunts or name-calling
Exclusion or spreading rumors
Cyberbullying
Threats or intimidation
Damage to personal property
Required
Please describe what happened in detail.
*
Your answer
Has this happened before?
*
Yes
No
Unsure
If you would like a trusted adult to follow up with you privately, provide your email address or name here.
Your answer
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