Incident Report Form
Bullying IS: on purpose, repeated over time and involves and imbalance of power
Physical: actions that hurt your body
Verbal: words that hurt your feelings
Friendship: words/actions that hurt your friendships, using a friendship or threatening to take friendship away
Cyber-bullying: intentional, repeated harmful behavior using technology
Bullying is NOT being:
Rude: Inconsiderate, thoughtless, unplanned behavior, bad manners, only thinking about yourself, not meant to actually hurt anyone (Ex. Burping, coughing, sneezing on others, bragging about the highest grade, cutting in line, horseplay, being disrespectful, getting in personal space)
Mean: Saying or doing something on purpose to hurt someone, maybe once or twice, usually in anger (Ex.criticizing or making fun someone’s clothes, looks, intelligence, skin, language, breaking or stealing others belongings)
My Name is:
Person submitting the report
Date the incident occurred:
Who was involved?
Describe the incident:
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This form was created inside of Lead Hill School District.