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Bullying Incident & Safety Concern Report
The Perkins Board of Education recognizes that both students and faculty/staff have the right to learn and work in a safe environment. Harassment, intimidation, or bullying behavior by any student or adult is strictly prohibited. In compliance with Ohio laws, Perkins Local School Schools has established this form as one avenue for the reporting bullying instances. Instances may also be reported by calling 419-502-2403 or 419-502-2433, ext 5003. All complaints will be promptly investigated.
Name of person submitting this bullying incident / safety concern report: *
Your answer
Relationship to individual impacted *
Student/Faculty/Staff Name *
Your answer
Location of incident/concern *
Type of incident or concern *
Required
Date of incident *
MM
/
DD
/
YYYY
Time of incident *
Time
:
Who was involved in the incident? *
Your answer
Please describe bullying incident or safety concern. Provide as much detail as possible. *
Your answer
In order for PLSD to contact you to follow up on your submitted incident/concern, the following information is needed.
Email address at which you can be reached. *
Your answer
Phone number at which you can be reached. *
Your answer
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