2017-18 Perquimans County Middle School Student Bullying Incident Report Form
Today's Date:
Your answer
Have you told the bully(s) to stop?
Did you try to walk away?
Date of Incident:
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Time of Incident:
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Where did it happen?
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Bully(s) Name:
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Victim(s) Name:
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Witnesses:
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Write a brief description of what happened.
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STAFF USE ONLY: Staff Member/ Date/ Notes
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