Bullying Incident Form
If you believe you have witnessed a bullying event on Herscher CUSD #2 property, please let us know. Please know that reports can be submitted anonymously. We appreciate your help as we better address this issue.
District property where incident was witnessed: *
Please indicate the seriousness of this incident per scale below: *
Please check all that apply: *
Required
When did this incident occur? (Include date and time) *
Your answer
To your knowledge, has it happened before? *
Required
Who was involved? Include the names of those directly involved and any bystanders/witnesses: *
Your answer
Briefly describe the situation: *
Your answer
To your knowledge, has there been any intervention? *
Required
Reported by: *
Date Submitted:
MM
/
DD
/
YYYY
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