Odyssey Community School Bullying Form
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Report of Bullying Form/Investigation Summary
Date *
Reporter Information *
If Staff member enter your name:
If Parent or Guardian enter your name:
If you are a student and do not want to remain anonymous enter your name:
Describe the alleged act of what happened:
Who committed the allleged bullying act? *
Who was the victim?
Time(s) of day alleged act(s) happened:
Frequency of alleged bullying-Explain
Example-(Only once, daily, twice a week etc.)
Location alleged bullying ocurred
(If by electronic device, please specify type and if possible attach any supporting documents, usernames, etc.):
Please write the name(s) of any potential witnesses.
Please share any additional information
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