Mandeville Junior High Safety Report

Use this form to report ANY problems that you experience or witness concerning students or employees of Mandeville Junior High. Please fill out the form to the best of your ability. You can leave blanks on questions that don't have a red * next to it, but with more information there is a better chance of a results.

TATTLING VS. REPORTING
Tattling: Wanting to get someone else in trouble or to get attention. (Inappropriate/False Report)
Reporting: Helping yourself or others to stay safe. (Appropriate/True Report)

ANY FALSE REPORTS WILL RESULT IN DISCIPLINARY ACTION(S) FROM THE SCHOOL AND/OR THE ST. TAMMANY PARISH SCHOOL BOARD

STPSB Social Networking Safety Video
First and Last Name (Optional)
Type the name of the person making the report.
Your answer
Grade
I am giving my name, but wish to remain anonymous.
Person/Situation That You are Concerned About *
Include first and last name if it is a person and if it is a situation, please be as specific as possible.
Your answer
Grade
Bully’s Name *
Write the first and last name of the bully or bullies.
Your answer
Grade
Names of Other Witnesses (if any)
Please include the first and last names of any witnesses or anyone who can collaborate your report.
Your answer
What is the date of the incident?
MM
/
DD
/
YYYY
Time
:
How long has this been going on? *
How many times has the student/target been harassed by this bully? *
Location (check all that apply) *
Required
Please provide specific details regarding the incident(s): *
Your answer
How severe/serious is the bullying? *
minor
extreme
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service