Bullying/Harassment Incident Report Form
Oklahoma School Security Act (70 O.S. § 24-100.3) requires each district to “…adopt a policy for the control and discipline of all children attending public school in that district, and for the investigation of reported incidents of harassment, intimidation, bullying, or threatening behavior.” This report form will assist districts in collecting reported incidents of such behavior.
Reporting Person's Name (optional)
Reporting Person's Relationship to the Person Being Bullied/Harassed (optional)
Where and when did the incident take place?
Student Initiating Bullying/Harassment:
Name of Witnesses (First and Last Names)
Type of Alleged Harassment
Is this a repeated offence?
Yes, this is a repeated offence.
No, this is a one-time incident.
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