Safety Box Form
Use this form to report any hurtful behaviors between students including bullying, harassment, physical aggression, or other unsafe behaviors.
Date of this Report: *
Your answer
Date of Incident: *
Your answer
When (what time did this happen)? *
Your answer
Names of students that were being hurt (target): *
Your answer
Names of student that were hurting others (aggressor): *
Your answer
Other students that saw what happened (bystander): *
Your answer
Please state what happened: *
Your answer
Location (where did this happen): *
Your answer
Your name (optional):
Your answer
email address (optional)
Your answer
Thank you for caring enough to fill out this form and make our school a safe learning environment!
You may also make a report in person to any trusted adult. You may also report any issue by phone (ext. 6174)
Submit
Never submit passwords through Google Forms.
This form was created inside of Champlain Valley School District. Report Abuse - Terms of Service