Foxview Intermediate School Bullying Reporting Form

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To report a bully means to do so in order to keep you or someone else safe (free from physical and emotional harm) and get the bully to stop. To tattle on someone means you are just trying to get them in trouble. Make sure you use this form to report a bullying incident. A school staff member will follow up on this report within 3 days that it is received.

Email *

Person reporting the incident *

Parent

Student

Staff

Other:

Name of person reporting the incident (optional)

Name(s) of individual(s) involved as bully *

Name(s) of individual(s) involved as victim *

Name(s) of individual(s) involved as witnesses *

Where did the incident take place? *

When did the incident take place? *

Type of bullying that occurred *

Check all that apply

Verbal (name calling, rumors, slurs)

Non-Verbal (excluding, threatening looks)

Written (Notes, threats, inappropriate drawings)

Social Media/Electronic (posts, messages, pictures)

Physical (hitting, pushing, physical aggression)

Other:

Describe as best you can what happened. Including dates if you can. *

The information that I have provided is true and complete to the best of my knowledge *

I agree

I would like to be contacted for more information or follow up as a result of the investigation of this incident *

Yes

A copy of your responses will be emailed to the address you provided.

Submit

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