Bullying Incident Report
In order to help to create a bully free environment, we have created a form for students, parents, and staff to use that will allow for reporting of bullying in our school. Please keep in mind that reporting bullying and harassment will be taken seriously. If further information is needed to investigate the report, we will need your contact information. There may be times when contacting the reporter is not appropriate due to privacy. Please be assured that all reports will be taken seriously and kept anonymous.
Status of person making this report *
Name of person making report (Not required) but helpful and will be kept anonymous.
Your answer
Name of person being bullied or harassed and their grade level. *
Your answer
Were you a witness to the bullying/harassment?
List any one else that was a witness to the incident.
Your answer
What is the name and grade of the person(s) doing the bullying. *
Your answer
What type of behavior was this? *
Where did this incident take place? Check all that apply. *
Describe the incident as detailed as you can. *
Your answer
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