Bystander Reporting Form
Type of Incident
Required
Who is the victim? If more than one victim, include all names.
Your answer
Who is the perpetrator (person doing wrong)? If more than one person, include all names.
Your answer
Time and Date of the incident
Your answer
Please describe the incident (give all details).
Your answer
Is this an ongoing problem or a one time incident?
Your answer
Where did the bullying happen?
Have you reported this incident to anyone yet? if so, to whom? (teacher, parent, etc.)
Your answer
Your name (Optional)
Your answer
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