This form is for reporting bullying. You may remain anonymous if you wish. If you identify others please give as much information as you can.
Name (optional - you can remaina nonymous or use pseudonym)
Surname (optional - you can remaina nonymous or use pseudonym)
I am a...
offical in an education department
The grade of the learner being bullied
Nature of the bullying
Physical (hitting, slapping, kicking, choking)
Emotional (being ridiculed, teased, humiliated, excluded)
Coercion & intimidation (being forced to do things through a threat of being hurt physically or emotionally)
Cyber bullying (being humiliated, teased or riducled on social platforms like Whatsapp & Facebook through pictures, video, audio or texts)
How often does it take place
Continually - at least twice a week
Frequently - at least once a week
Often - at least 3 times a month
Occasionally - once or twice a term
How many people are involved
One particular perpetrator
One main perpetrator and a group of followers
More than one perpetrator with each pepetrator as mean as the other
The bully is...
A learner/learners at my school
A learner/learners at another school
An adult outside the school
Write a short report here. It is important to give details of the bully like his or her name and their class if you know it. Where it ocurs and what it is about. If you want us to take it further (As in a disciplinary hearing) you will have to submit a contact number or e-mail adress below.
Contact detail (Only if you want feedback or for us to institute a disciplinary hearing)
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