Harassment, Intimidation, Bullying Report
Electronic Report Submission Instructions

Please use this electronic Report Form to communicate witnessed acts of Inappropriate Behavior, Conflict, Accident, and/or potential acts of Harassment, Intimidation, and Bullying (HIB).

Please note: Consequences will not be applied based solely on the information submitted within this report. All incident reports initiate an investigation by the district Anti-Bullying Specialist. Any person filing false information will face school consequences and possible police notification.

I am a... *
Reporter Name (optional)
Record your name - First Last
Your answer
I would like to communicate... *
I am requesting... *
Incident Date: *
MM
/
DD
/
YYYY
Incident Time *
Location *
Accused Student(s): *
Please identify accused student(s) by name (ie: Thomas Jones)
Your answer
Target Student(s): *
Please identify the target student(s) by name (ie: Thomas Jones)
Your answer
Witness(es):
Please identify all witness(es) by name (ie: Thomas Jones)
Your answer
Incident Description *
Please include as much factual information as possible.
Your answer
I believe the incident reported above to be considered Harassment, Intimidation, and/or Bullying (HIB) under New Jersey Law Because... *
Please check all that may apply:
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Avon School. Report Abuse - Terms of Service - Additional Terms