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)
Your answer
Student(s) who was/were targeted *
Your answer
When did this occur? *
MM
/
DD
/
YYYY
What time of day? *
Required
Grade(s) of students targeted *
Required
Alleged offender/bully *
Your answer
Location of the incident: *
Required
If you have any more specific information on where/when this happened, please include here:
Your answer
Type of aggressive behavior (check all that apply): *
Required
Write a specific description of what happened: words that were said, how many times, etc. *
Your answer
List of names of peers who were present and near enough to witness or overhear the incident:
Your answer
Were adults present? *
If yes, please provide their name and a description of what they did:
Your answer
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