Student Incident Report Form
Please use this form to report any instances of Rude/Mean/Bullying behaviors. This form is NOT for reporting self harm or suicidal thought concerns. If you or someone you know is thinking of hurting themselves, please talk to your trusted adult or call 911.
Today's Date *
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Name of Student Reporting the Incident
You are not required to answer this question
Grade of Student Reporting the Incident *
Required
Name of other Students Involved in the Incident *
Grade of Student(s) Involved the Incident *
Required
Where did the incident happen: *
Brief description of the situation *
Describe here WHO was involved, WHAT happened, WHERE it happened, and WHEN it happened. Be as descriptive as possible. If you are using this to report someone who is thinking of hurting themselves or you are thinking of hurting yourself, please contact a trusted adult or call 911.
Was this incident: *
Required
I am reporting this incident because: *
Required
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