OLCHS Bullying Report Form
Use this form to report an incident of harassment, bullying, or cyber-bullying. You have the option to make the report anonymously. If you need immediate assistance, please contact your dean or guidance counselor.
I am a *
Type of Incident *
How did you become aware of the incident? *
Did you report the incident to a staff member? If yes, Who?
Your answer
Please describe what happened *
The more detail you provide the better
Your answer
Alleged Bully -List more than one if necessary *
Your answer
Alleged Victim(s) *
If you are the alleged victim and wish to remain anonymous, just enter the word "Me" in the box below.
Your answer
Witnesses/Bystanders
Please list others that observed the incident or could provide more details.
Your answer
Date and Time of the Incident
Your answer
Location of the Incident
Your answer
What type of help would you like with this issue?
Your answer
Please provide additional details or information to assist the school staff
(if you are being cyberbullied, please save screenshots from the incident)
Your answer
Your Name
Optional, but helpful
Your answer
Contact Information
Optional, Email Address or Phone Number
Your answer
Submit
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