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.
Email address *
Reporting Person's Name (optional)
Your answer
Reporting Person's Relationship to the Person Being Bullied/Harassed (optional)
Your answer
Where and when did the incident take place?
Your answer
Student affected:
Your answer
Student Initiating Bullying/Harassment:
Your answer
Name of Witnesses (First and Last Names)
Your answer
Type of Alleged Harassment
Is this a repeated offence?
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