Bullying Incident Report for TVCS
For students or parents. This report will be read by an administrator or designee. All reports will be investigated.
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Email *
DATE OF INCIDENT *
MM
/
DD
/
YYYY
TIME OF INCIDENT - BE AS SPECIFIC AS POSSIBLE *
DID THIS HAPPEN AT SCHOOL? *
IF NOT AT SCHOOL, WHERE DID THIS HAPPEN?
IF THIS HAPPENED AT SCHOOL, WHAT WAS THE LOCATION?
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DESCRIBE THE INCIDENT *
NAME THE VICTIM(S) *
NAME THE PERSON(S) WHO WAS/WERE BULLYING *
NAME ANY PERSON THAT WAS A WITNESS/BYSTANDER *
ANY PHYSICAL INJURIES? *
PLEASE NAME ANY ADULT THAT THIS WAS REPORTED TO
OPTIONAL: YOUR NAME
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