Bullying Incident Report Form
If you have been the target of bullying or have witnessed the bullying of a District student, complete this form. Complaints against students will be given to the building Principal. Complaints against building Principals will be given to the Superintendent. Complaints against the Superintendent will be given to the Board of Education. Reports of bullying will be investigated and disciplinary action will be taken as warranted.
*Students have the right to complete this form anonymously. However, it will be easier for the District to investigate this matter if as much information as possible is provided. Submission of a good faith complaint or report of bullying or harassment will not affect the complainant or reporter's future employment, grades, learning, or working environment. A complainant that falsely accuses someone will be subject to disciplinary action.
You are a:
Date(s) of alleged bullying:
Name of person(s) subjected to bullying:
Person(s) alleged to have committed the bullying or harassment:
Summarize the incident(s) or occurrence(s) of bullying as accurately as possible.
Names of Witnesses:
Have you reported this to anyone else?
If Yes, Who did you report it to?
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This form was created inside of Putnam Co R-I Schools.