Describe the details of the incident (including names of people involved, what occurred, and what each person did and said, including specific words used)
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Name of Target (of behavior):
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Name of Aggressor (Person who engaged in the behavior)
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Date(s) of Incident(s)
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Time When Incident(s) Occurred:
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Location of Incident(s) (Be as specific as possible)
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Witnesses (List people who saw the incident or have information about it):
Witness 1 Name (Indicate if Student, Staff or Other)
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Witness 2 Name (Indicate if Student, Staff or Other)
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Witness 3 Name (Indicate if Student, Staff or Other)
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