Bully Report Form
“Bullying” is behavior where one person or group engages in REPEATED harmful action towards another person or group acting on a real or perceived IMBALANCE of power or view of superiority. The behavior typically includes verbal (e.g. teasing or name-calling) and physical aggression (e.g., hitting, pushing), threatening, excluding or ignoring, spreading rumors, or taking, defacing or destroying the others’ property.
“Cyber-Bullying carries the same definition as bullying but involves students using a digital medium to participate in the bullying. To include but not limited to texting, messaging, emailing, or social networking that is intended to bully another student and disrupts the educational process. Whether the act takes place on or off school grounds and using a school or personal electronic device if it disrupts the educational process it is subject to disciplinary action.
Name of person reporting the incident (optional)
Date and Time of incident
Where did the incident take place?
Type of Bullying
Physical (Example: Hitting, Spitting, Kicking, Pushing)
Emotional (Example: Social Exclusion, Spreading gossip, Intimidation)
Verbal (Example: Threats, Name calling, Gossiping, Taunting, or Teasing)
Sexual (Example: Sexual Remarks or Gestures, Innuendos or Gender related comments)
Cyber (Examples: Text, Chats, Email, Facebook, Twitter)
Racial (Example: Racial slurs, Jokes, Innuendos, or Comments)
Description of Incident/Incidents
Name of a contact person or witness
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