Bullying/Incident Report Form
Please give as many details as possible. This will help us investigate the matter in a most thorough way. Thank you for helping keep our students safe.
Reporter Name (not required)
Student(s) who was/were targeted
When did this occur?
What time of day?
After school on campus
Outside of school
Grade(s) of students targeted
Location of the incident:
If you have any more specific information on where/when this happened, please include here:
Type of aggressive behavior (check all that apply):
Told lies of false rumors
Targeting gender and/or sexual orientation
Write a specific description of what happened: words that were said, how many times, etc.
List of names of peers who were present and near enough to witness or overhear the incident:
Were adults present?
If yes, please provide their name and a description of what they did:
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