CSMS Say Something Online Reporting Form

The purpose of this form is to create effective interventions and to help prevent criminal activity, violence, suicide, bullying, self-harm and other forms of threatening behavior.

It’s easy and completely confidential to report safety concerns.


» Assault

» Abuse (physical, verbal)

» Bullying or regular intimidation

» Bragging about an upcoming planned attack

» Depression, anxiety or loss of self-control

» Fighting

» Gun Violence / Violence

» Harassment

» Hopelessness, excessive guilt or worthlessness

» Reckless behavior

» Social isolation or withdrawal

» Substance abuse

» Suicide threats, cutting or other self-harm

» Theft

» Threats

» Weapons (use of and/or discussion about)

Sign in to Google to save your progress. Learn more
Email *
The type of incident being reported is: 
Name of Student Victim: 
Grade of Student Victim:
Name of Student Offender(s): 
Grade of Student Offender(s):
Where did the incident happen? *
(Choose all that apply and please select at least 1)
When did the incident happen? *
(Select at least 1)
Please describe the incident in more detail. *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Buckeye Union School District. Report Abuse