Bullying Report
Please use this form to report an incident of bullying involving an individual associated with South Adams Schools. This report is anonymous but you can choose to leave your name and contact information at the end. Educators are required by law to report bullying and should use the form on the South Adams Staff page.
I am a *
mark all that apply
Required
The bully (person doing the bullying) is *
if multiple bullies please list all names
Your answer
The victim (person being bullied) is *
please list actual name (not "me"); if multiple victims please list all names
Your answer
The type of bullying is *
mark all that apply
Required
How did you find out about this bullying incident? *
mark all that apply
Required
When did the bullying occur *
MM
/
DD
/
YYYY
Where did the bullying occur? *
if multiple places please list them all
Your answer
Is this bullying still happening? *
Has this bullying been reported before by you or someone else? *
If yes, to whom was it reported to? Include name and tile (Mr. Smith, teacher; Mrs. Jones, cook) *
if no please enter None
Your answer
Please describe in detail what happened during this bullying incident. Include the names of the bully, victim and anyone else that witnessed the bullying. *
Your answer
Your responses are confidential but you may choose to leave your name, email address and/or phone number. You may be contacted for additional information. Staff members at South Adams are required to leave their name.
leaving this blank will ensure your responses being annonymous
Your answer
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