Bullying and Harassment Incident Form
This form is to be used to report incidents of bullying and harassment at Algoma Middle and High School.  All reports of bullying and harassment will be sent to school administration and the school resource officer.  Information provided will be kept confidential
Sign in to Google to save your progress. Learn more
Person Reporting Incident

Provide First and Last Name
 *
Who was being bullied/harassed?

If you were the victim and want to remain anonymous, please type "me".
 *
Who was doing the bullying/harassing?

 *
When and where did the bullying/harassment take place?

If you recall the exact time and location it occurred please provide that information.
 *
What happened?

Describe the incident(s), include how the incident started, those involved, and details of the event (what they said or did).
 *
Did anyone witness the bullying harassment?

If so, name the witnesses:
 *
Comments or additional information (OPTIONAL) *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Algoma School District.

Does this form look suspicious? Report

Google Forms