Bullying Incident Report Form - OEE & OSS ONLY
The PSB expects that all members of the school community will treat each other in a civil manner and with respect for differences. The PSB does not tolerate bullying or retaliation, in school buildings, on school grounds, or at school-related activities. All staff members who witness or become aware of bullying or retaliation by any student or staff member must inform the Principal/Head of School/Superintendent or his/her designee immediately. 

This form may be used for reporting bullying or retaliation. For more information, please refer to the PSB Bullying Prevention Policy and PSB Bullying Prevention and Intervention Plan, available at all schools and on the PSB website. You can choose to file this report anonymously. However, please be advised that reporting anonymously limits our ability to take disciplinary action in response to an incident(s).

This form will be received by the PSB Office of Educational Equity and Office of Student Services ONLY.
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Anonymity: *
1. Enter YOUR name, the name of the person filling out the form.
You may choose to make this report anonymously by not telling us your name. However, it may impede the investigation in the event that we have clarifying questions about your report.
2. Please enter your contact information (phone number and email address).
Entering your phone number and email address enables PSB to get in touch with you. This is optional, but advised.
3. What are you reporting? I am reporting... *
4. What is the primary school association for this incident? This is the school(s) where the alleged AGGRESSOR(s) attends. *
The "AGGRESSOR" is the person being accused of harassment or bullying. 
Required
5. Are you the TARGET of the incident or the person reporting it? *
The "TARGET" is the person on the receiving end of the alleged harassment or bullying.
6. Are you a: *
7. Name of the person(s) TARGETED: *
The "TARGET" is the person on the receiving end of the alleged harassment or bullying. If you do not know, please write "Unknown". 
8. TARGETED person's school: *
Required
9. Please include the date or dates of incident(s). *
Date of the incident being reported, or multiple dates for multiple incidents. If you do not recall specific dates, please provide as many details as you recall (week, month, time of day - morning/afternoon, etc).
10. Did the incident(s) occur on school grounds? *
11. Where did the incident(s) occur? *
12. Name of the alleged AGGRESSOR(s): *
The "AGGRESSOR" is the person being accused of harassment or bullying. If not known, write "Unknown".
13. If alleged AGGRESSOR(s) is a student, please list their grade: *
If grade is not known, write "Unknown".
14. If known, please list other individuals involved in this incident by names and roles (witnesses, bystanders, staff, etc).
15. Describe the incident or incidents.  *
 Please include as much information as possible (names of all individuals involved, what occurred, what each person did and said, including words used). Please include what each witness experienced, saw, or heard. 
16. Would you like an administrator to contact you regarding this report? *
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