Bullying Report Form
What is bullying? Bullying is when someone repeatedly and on purpose says or does mean or hurtful things to another person who has a hard time defending himself or herself.
Relationship to victim:
If reported to you by someone else, indicate who:
Date(s) of incident:
Type of bully?
Non-verbal (exclusion, eye-rolling, etc...)
Who was bullied? (Please list first and last names and grade level of all students, if reporting multiple students.)
Who did the bullying? (Please list first and last names and grade level of all students, if reporting multiple students.)
Where there any bystanders? If yes, please list first and last name.
Where did it happen?
What time of day?
Has this happened before?
NO, this is the first time.
YES, this has happened once before.
This is an ongoing problem
Briefly describe the incident:
Any other information we need to know?
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