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.
Your Name:
Your answer
Relationship to victim: *
If reported to you by someone else, indicate who:
Your answer
Date(s) of incident: *
Your answer
Type of bully? *
Who was bullied? (Please list first and last names and grade level of all students, if reporting multiple students.) *
Your answer
Who did the bullying? (Please list first and last names and grade level of all students, if reporting multiple students.) *
Your answer
Where there any bystanders? If yes, please list first and last name.
Your answer
Where did it happen?
Your answer
What time of day?
Has this happened before?
Briefly describe the incident: *
Your answer
Any other information we need to know?
Your answer
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