Reporting Bullying
This form will be used to report instances of bullying is a anonymous manner. This form will be checked daily to be ensure Bullying is not continued on our campus.
Name or Email Address (optional)
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Today's Date
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Date of Incident
Your answer
Person Filling out this Form (optional, but helpful)
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I am a...
Where did this incident happen?
Please identify the alleged person or person's responsible for the reported incident.
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Date of the Incident
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Time of the Incident
Time
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Location of the Incident (Be Specific ie: jh girls locker room at HS)
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Type of Harrasment
Witnesses (please list anyone who saw or heard the incident, or who might have knowledge of what happened)
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Nature of the Incident (check all that apply)
Describe the incident in full detail. (Be sure to include the names of people involved, what was said and done and the EXACT words used.)
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