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SAFE SCHOOL REPORT / Bullying
Bullying among children is commonly defied as intentional, repeated hurtful acts, words or other behaviors committed by one or more children against another. Bullying may be physical, verbal, sociall/emotional or sexual in nature. There are three aspects of this hurtful behavior that almost all experts agree on; in bullying there is a difference in power between those being hurt and those doing the hurting, bullying involves hurtful behaviors that are repeated and intentional. if you are a student, the parent/guardian of a student, a close adult relative of a student, or a school staff member and wish to report an incident of alleged bullying, harassment or intimidation, complete this form. You may contact the school for additional information or assitsance at any time.
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Name of Victim *
Name of Student(s) bullying:
Name of witnesses/bystanders:
Your name (optional)
Person reporting incident
Location of incident:
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Date of Incident *
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DD
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YYYY
Time of Incident *
Time
:
Repeat infraction?
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Type of bullying:
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Bullying behaviors
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Describe the incident
Why did the bullying, harassment, or intimidation occur?
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