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Harpeth Middle School Bully Report
This report is confidential and will be sent directly to Mr. Philipp and Mr. Baker upon completion
Adult(s) Helping to Complete this Form
Current Date and Time
Person(s) Doing the Bullying
General Description of the Behavior being directed towards you
Other Witnesses to This Behavior
How many times has this behavior occurred?
3 or more Times
Where does this behavior usually occur?
How long has this behavior been going on?
Have you reported this behavior and if so, when?
This is a single example of bullying behavior
This is behavior that represents a pattern because it has been occurring consistently and has made me feel scared, threatened, or upset on a regular basis.
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