Bullying and Harassment Incident Report
This form is to be used to report incidents of bullying and harassment at SPASH. All reports of bullying and harassment will be sent to school administration and the school resource officer. Information provided in the report will be kept confidential.
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Person Reporting Incident
Provide First Name and Last Name
 *
Who was being bullied/harassed?
If you were the victim and want to remain anonymous, please type "me".
 *
Who was doing the bullying/harassing? *
When and where did the bullying/harassment take place?
If you recall the exact time and location it occurred please provide that information.
 *
When did the incident of bullying/harassment take place?
MM
/
DD
/
YYYY
What happened?
Describe the incident(s), include how the incident started, those involved, and details of the event (what they said or did).
 *
Did anyone witness the bullying/harassment?
If so, name the witnesses:
Comments or additional information (OPTIONAL)
Submit
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