Bullying Incident Reporting Form
The Cheshire Board of Education promotes a secure and positive school climate, conducive to teaching and learning, that is free from any type of bullying behavior. Anyone who witnesses bullying is asked to report the incident to the school administration immediately. All reports will be thoroughly investigated and appropriate action will be taken.
Date of Report *
mm/dd/yyyy
Your answer
Person Reporting Incident *
If you prefer to remain anonymous, type "anonymous".
Your answer
Student Reported as Committing Act *
Your answer
Student Reported as Victim: *
Your answer
Date Incident Occurred *
mm/dd/yyyy
Your answer
Location of Incident *
Your answer
People Involved in Incident *
First and last names, if known.
Your answer
Description of Incident *
Be as specific as possible.
Your answer
Other Witnesses *
Both first and last names. If you prefer the witnesses remain anonymous, type "anonymous". If no other witnesses were present, type "none".
Your answer
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