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SY 2019-20 Safe Schools and Bullying Prevention **Investigation Form**
HOT LINE: (617) 592-2378
BOSTON PUBLIC SCHOOLS
Succeed Boston - Safe and Welcoming Schools
All Safe Schools and Bullying Prevention hotline calls will be answered by trained counselors from the Boston Public Schools Succeed Boston. All allegations made will be forwarded to Principals and Headmasters. It is imperative that the Principal, Headmaster or his/her designee contact the parent/ legal guardian within 48 hours upon receipt of the report. Collaboration with parents is essential to identify the issues occurring at school as well as developing the best safety and or action plan to remedy the situation.
All investigations, findings, and recommendations must be completed within 5 school days and results shared with parents of alleged targets and aggressors. Upon completion the investigation must be sent via this form (Safe Schools and Bullying Prevention - Investigation Form) to Safe and Welcoming Schools - Succeed Boston Department. For questions email
All allegations regarding bullying based on race, color, national origin, ethnicity, religion, sex, sexual orientation, gender identity, disability, age, genetics, or active military status will be submitted to the Office of Equity for review of potential civil rights violations. School staff investigating these allegations must also send the findings to the Office of Equity.
Definition of Bullying: According to the Massachusetts Department of Elementary and Secondary Education, bullying is defined as "the repeated use by one or more students [aggressor(s)] of a written, verbal or electronic expression or a physical act or gesture or any combination thereof, directed at a target that: (i) causes physical or emotional harm to the target or damage to the target's property; (ii) places the target in reasonable fear of harm to him/herself or of damage to his/her property; (iii) creates a hostile environment at school for the target; (iv) infringes on the rights of the target at school; or (v) materially and substantially disrupts the education process or the orderly operation of a school. For the purposes of requirements related to this law, bullying shall include cyber-bullying. See Section 5 of the legislation for more details on the definition of cyber-bullying and more". For more information visit the Boston Public Schools anti-bullying page:
1) Today's Date:
2) Name and role of the person investigating this bullying allegation:
3) What is the name of your school?
BOSTON ARTS ACADEMY
BOSTON GREEN ACADEMY
BOSTON LATIN SCHOOL
COLLEGE BOUND MIDDLE SCHOOL
DAY AND EVENING ACADEMY
DORCHESTER YOUTH ACADEMY
DUDLEY ST CHARTER
EXCEL HIGH SCHOOL
GARDNER PILOT ACADEMY
J. F. KENNEDY
MARY LYON HIGH SCHOOL
MIDDLE SCHOOL ACAD
NEW MISSION HIGH
UMANA ACADEMY K-8
UP ACADEMY DORCHESTER
UP ACADEMY BOSTON
WEST ZONE ELC
4) How did you receive the bullying allegation or how was the bullying allegation form completed?
My school received it from Succeed Boston (Hotline Service)
The Superintendent's Office sent the allegation to my school
The Mayor's Help Line sent the allegation to my school
A parent /guardian completed the bullying allegation at school with a staff
5) Name of the person who filed the bullying allegation you are investigating?
6) Name of the student who is the target of bullying? (Here you may explain if in this case and investigation the target is also the aggressor.)
7) Grade of the student who is being targeted?
8) Name of the student who is engaging in the bullying behavior? (Here type the name of the aggressor or aggressors)
9) Grade of the student who is engaging in the bullying behavior?
I don't know
10) Date, time, and location of the incidents?
11) If the bullying is happening on a school bus, please list the bus number.
12) Witnesses: List the name of the people who saw the incident or have information about it:
13) Does this allegation involve a protected class? (Race, color, national origin, ethnicity, religion, sex, sexual orientation, gender identity, disability, age, genetics, or active military status.) All reports regarding Civil Rights Violations of protected classes will be forwarded to the Office of Equity for tracking and, if necessary, further investigation, (Sections 1, 21.1 and 21.2 of the Code of Conduct). If yes, did you forward this allegation and investigation to the Office of Equity?
This allegation does not involve a protected class
14) Has the aggressor been interviewed?
15) When was the aggressor interviewed?
16) Has the target been interviewed?
17) When was the target interviewed?
18) Has the witness or witnesses been interviewed?
19) When was the witness or witnesses interviewed?
20) Are there prior documented incidents by the aggressor?
Maybe (I don't know)
21) If yes, were these incidents involving a protected class?
22) Are there any previous incidents of aggressor involved in bullying or retaliation?
23) Summary of Investigation:
24) Conclusion from the Investigation. Choose the answer that best fits with the investigation's findings:
Yes - The investigation found bullying
Yes - The investigation found retaliation
Yes - The investigation found bullying and retaliation
No - The investigation found NO bullying
No - The investigation found NO retaliation
No - The investigation found NO bullying NEITHER retaliation
Neither bullying or retaliation. This was an isolated CONFLICT
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