LHS See Something - Say Something
Fill in the See Something-Say Something to the best of your ability. When you click on submit, your form will be automatically sent to your school administrators and guidance counselors. This form is confidential.
When did the incident happen? (date)
When did the incident happen? (time)
Where did the incident occur?
Name(s) of the individual(s) that were harmed.
Who were the individuals who caused the harm? If you do not know their names, fill in "I did not recognize them."
List any potential bystanders or witnesses.
Please check all that apply.
Teasing, Taunting, and/or Insulting
Name calling or verbal abuse
Intimidation or threats
Starting or spreading of rumors
Purposefully causing embarrassment or humiliation
Purposefully ignoring or excluding
Destruction of personal property
Physical intimidation (pushing and/or shoving)
Racial or religious insults
Verbal and/or physical threats
Bullying through the internet
Bullying through a mobile device
Other bullying behavior
Describe in detail what happened. Give as much information as you can.
Who are you? (Including your name will help the principal or counselor keep students safe).
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This form was created inside of School District of Lodi.