"Bullying is when someone repeatedly and on purpose says of does mean or hurtful things to another person who has a hard time defending himself or herself"
Three Key Components of Bullying Behavior
1. Involves an aggressive behavior
2. Typically involves a pattern of behavior repeated over time
3. Imbalance of power or strength
-Olweus Definition & Components of Bullying
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I am a
During the incident I was a
Bystander (I saw the bullying take place)
Was told by someone else about the incident
What is your name?
THIS IS OPTIONAL
If you are a student, what grade are you in?
Not a Student
What is the name of the student you would like to report. If you do not know the name of the student, please describe them.
When did the incident take place?
About what time did the incident take place that day?
Where did the incident take place? (Please be Specific)
ex. In the cafeteria bathroom, In the back half of bus 228, etc.
Please describe the incident. (Give details and be as specific as possible)
Were there witnesses to the incident?
What were the names of the witnesses?
Please describe the frequency with which this type of incident occurs
ex. everyday, once a week, once a month, etc.
How do you feel about this incident of the people involved?
ex. They are annoying, I hate them, I want to hurt them, They don't make me mad I just want it to stop, etc.
Did this or other incidents make you feel like harming yourself or others?
Would you like to speak with a counselor? (If you answered "Yes" to the last question, then please write your name in the previous question above that asks "What is your name?")
What else would you like us to know about this incident? (Is there anything you have not been able to share above that is important to know?)
Please describe any evidence that exists of the bullying (letters, photos, texts, etc.). If you can provide this, please leave with a counselor or a principal.
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This form was created inside of Randolph County School System.