CIC Bullying Report Form
Every student has a right to feel safe and protected. By letting us know of any concerns you might have, we can begin the process of supporting those who need our help in stopping bullying from continuing. It is always the right thing to let a trusted adult know if bullying happens.

CIC Anti Bullying Code:
● In our school everyone is valued.
● The students of this school have the right to be themselves and the responsibility to treat others as they would like to be treated.
● We speak out when we know we should. Silence allows people to suffer .You must act.
● If you are bullied keep telling until someone helps you.
● Students who persistently bully may be suspended/expelled.

1. Name of the student(s) being bullied?
Your answer
2. Class
Your answer
3. Names and classes of students engaged in bullying behaviour
Your answer
4. Location of Bullying Incidents
5. Name of person reporting the bullying incident
Your answer
6. Contact details of person reporting the bullying incident
Your answer
7. Type of Bullying Behaviour
8. Where behaviour is regarded as identity based bullying, indicate the relevant category
9. Please give a brief description of the bullying and its impact
Your answer
Submit
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