Bullying Report Form
Lincoln County School District has a Zero Tolerance policy regarding bullying. If you experience or see any type of bullying, you must report it to a staff member.

Use this form to report any bullying you experience or see at school, on the bus, or during any school activities.

What should you report?

- Physical intimidation/assault
- Oral or written threats
- Teasing
- Put-downs
- Name-calling
- Threatening looks
- Inappropriate gestures
- Rumors
- Social Isolation
- Cyberbullying (cell phone, e-mail, Facebook, etc.)

Date of incident(s):
MM
/
DD
/
YYYY
Your Name:
(optional)
Your answer
Name of bully(ies):
Your answer
Name of person(s) being bullied:
Your answer
Location of incident(s):
Your answer
Describe incident:
Your answer
What did you do?
Your answer
Witness names:
Your answer
Submit
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