Campus Bullying Report Packsaddle Elementary
What campus is the bullying occurring?
Where did the incident occur? (Please give details of location.)
What is the race of the victim?
What is the age of the victim?
What is the gender of the victim?
Date of Incident:
Type of Incident?
Who was bullying, harassing, intimidating or causing harm? (Include first name, last name and grade if known.)
Who was the person being harmed, bullied, harassed or intimidated? (Include first name, last name and grade if known.)
Did you witness the bullying firsthand?
Were there any other witnesses? If so, please list their names here:
Describe what happened. Give as much information as you can.
Was law enforcement contacted? If yes, then type who was contacted.
Reporter Information (Who is reporting this information?)
(OPTIONAL) What is your name? (PLEASE NOTE: Anonymous reports are accepted however they must provide sufficient evidence to justify the commencement of an investigation. Formal disciplinary action may not be based solely on an anonymous complaint.)
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