Delano Public Schools Bullying Report Form
What is bullying? Bullying is when someone repeatedly and on purpose says or does mean or hurtful things to another person that may have a hard time defending himself or herself.
Your name *
Your relationship to the person allegedly being bullied *
Building person/student attends. *
If reported to you by someone else, indicate who (first, last name) *
Date of Incident *
MM
/
DD
/
YYYY
Type of Bullying/Harassment *
Who was bullied? Please list first and last names of all students if more than one person was bullied. *
Who did the bullying? Please list first and last names of all students if more than one person was bullying. *
Were there any by-standers/witnesses? Please list first and last names of all students if more than one person was witnessing the event(s). *
Where did the bullying behavior occur? *
Specific location from above
Time of Day? Add exact time below, if known. *
Exact time(s) of the day or class period *
Has/Did this type or other types of bullying the the same persons (people) before?? Please explain below with dates/times etc. Is this the first time, second time or on-going type of bullying? For how long? *
Briefly describe the incident. What did YOU actually see (witness) and/or hear? *
Is there any other information that we need to know?
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