ECSD Investigation of a Bullying Incident (Report)
If you have observed or been the victim of bullying, please complete the enclosed form. An administrator will investigate and report back within 24-48 hours.
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Name of Student Making the Report
Building Incident Occurred
Name of Victim:
Name of Suspect:
Name of Potential Witnesses:
Location Incident Occurred
Date Incident Occurred
MM
/
DD
/
YYYY
Time Incident Occurred
Time
:
Report of Incident - Describe what occurred, who was involved.
Name of person the incident was reported to:
Type of Incident
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Allegations Based on:
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What else would you like to share?
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