BULLYING INCIDENT REPORT FORM
Reporting bullying or harassing behavior is the first step toward making our schools a safe place for everyone (this includes cyberbullying). Please report bullying if you are experiencing it, or witness it in school, on the bus, at school events, or online.

Use the following form to report bullying, which includes incidents of cyberbullying. Complete it online and it will be submitted directly to administration. Reports are held in the strictest of confidence.

Whether you are a witness or target in this case, we want to thank you for helping us maintain a positive and safe school environment for all of our students. (All names provided are kept confidential.)

Name (optional)
Your answer
Today's Date (optional)
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Email (Optional)
Your answer
Phone# (Optional)
Your answer
Would You like to be contacted? *
Please choose a school from the dropdown list. *
Please choose a grade from the dropdown list. *
Who is/are the person(s) doing the bullying? *
Your answer
Describe the incident(s) and how long it has taken place? Be as specific as possible.​ *
Your answer
Did anybody else witness this incident? If so, who?​ *
Your answer
Has any school staff been notified about this incident? If so, who and when were they notified?​ *
Your answer
Where did this happen? (For example, the bus stop, the cafeteria, on the internet, etc.)​ *
Your answer
Date Bullying Occurred *
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Time Bullying Occurred *
Time
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