Incident Details
Complete the below questions in as much detail as possible. Include name(s) of individuals involved, date(s) the incident took place, the location(s) of the incident as well as a description of the incident.
Email address *
Name of School *
Name of person making this report *
Relationship to the person making this report: *
Required
Name of target AND grade Level AND student ID # *
Name of alleged offender(s) AND grade level AND student ID # *
List any witnesses to this incident and include their grade level *
Date of incident *
MM
/
DD
/
YYYY
Approximate time the incident occurred *
Time
:
Where did the incident occur? *
Required
Check which best describes he alleged harassment, intimidation, and/or bullying (HIB) behavior the target was subjected to: *
Required
Identify what harm you believe was or may have been cause by the alleged incident. Check all that apply.
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