Report of Bullying Investigation Sheet
N.C. General Statute 115C-407.15 - Bullying and Harassing Behavior Definition: Bullying or harassing behavior is any pattern of gestures or written, electronic, or verbal communications, or any physical act or threatening communication that takes place on school property, at any school-sponsored function, or on a bus, and that (1) Places a student or employee in actual and reasonable fear of harm or (2) creates or is certain to create a hostile environment by interfering with or impairing a student's educational performance, opportunities, or benefits.

Bullying or harassing behavior includes, but is not limited to, acts reasonably perceived as being motivated by any actual or perceived differentiating characteristic, such as race, color, religion, ancestry, national origin, gender, socioeconomic status, academic status, gender identity, physical appearance, sexual orientation, or mental, physical, developmental, or sensory disability, or by association with a person who has or is perceived to have one or more of these characteristics.
Person Reporting
Date of the Report
Who was the perpetrator?
Who was the victim?
Where did the offense occur?
Clear selection
What are the details of the report received? (include names and very specific information)
Details of the investigation (Be specific to include all names involved)
Was the incident determined to be bullying? *
Additional Details (Follow up plan with the victim, preventative measures implemented, etc)
Never submit passwords through Google Forms.
This form was created inside of Stokes County Schools. Report Abuse