JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Bullying Report
Each of the Sahtu Divisional Education Council Schools highly respect and care for your privacy. We do not collect or store any personal information about you when you submit your alert tip unless you voluntarily provide it. Any information provided will be kept strictly confidential.
We will take your concerns seriously and investigate each situation. The SDEC is committed to providing all students with a safe learning environment that is free from bullying and cyberbullying.
This form is not done until you click "Submit" on the bottom of the end page.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
You are submitting this form as:
*
the victim
a witness
a concerned person
Grade Level of person affected by behaviour:
*
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Aggressor’s Name(s) (optional)
Your answer
Aggressor’s Grade Level(s)
*
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Required
Incident Date*
*
MM
/
DD
/
YYYY
Where did it happen?
*
Classroom
Hallway
Bathroom
Cafeteria
Outside
Internet
Cell phone
Bus
Gym
On the way to school
Bus stop
Facebook, Instagram, Snapchat, TikTok, other social media site
Cell phone/text message
Other:
When did it happen?
*
Before school
After school
Morning
Lunchtime
During class
Afternoon
Other:
What kind of bullying behaviours?
*
Shoved/pushed
Excluded
Staring/leering
Hit, kicked, punched
Threatened
Stole/damaged possessions
Hurtful graffiti
Teasing/ridiculing
Told lies about or false rumors
Inappropriate touching
Stalking
Racial discrimination
Sexual discrimination
Disability discrimination
Cyber-bullying [cruel posts, picture sharing, harassment, etc...]
Other:
Did Physical Injury result from this incident?
*
Yes, but medical care was not needed
Yes, medical care was needed
No
What else would you like us to know about this incident?
Your answer
We would like to offer our confidential support, if you’re comfortable sharing your name
Your answer
What is your school?
*
Mackenzie Mountain School
Chief Albert Wright School
Ehtseo Ayha School
Chief T'Seleye School
Colville Lake School
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Sahtu Divisional Education Council.
Report Abuse
Forms