Argonaut's Bully Incident Report

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Upon receipt of this digital alert form a formal investigation will take place or occur. More information will be collected as outlined and required through the California's Seth's Law.
https://www.aclusocal.org/en/seths-law

Today's Date *

YYYY

Reporter- Your Name is Optional

Phone number or email you can be reached at (optional)

Role of person reporting the incident *

Student Target

Student (witness)

Parent/Guardian

Staff Member

Other

What was your involvement in the incident? *

I was directly involved

I observed the incident

I heard about the incident

Name of Student Target *

Grade of Target (optional)

Description of Incident *

Name(s) of other who may have witnessed the incident?

Is this a reoccurring situation? *

Yes

Were there any adults around when the incident occurred? *

Yes

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