Bullying Incident Report Form
Your Name:
The person(s) involved in this report will NOT know who reported it, we are only collecting your name in case we need to ask follow up questions.
Your answer
Name of the person doing the bullying behavior:
Your answer
Contact Information:
If you are NOT a student, how can we get ahold of you in case we have questions or need to follow up?
Your answer
Who was/is involved in the situation?
List ALL known participants in the event including potential witnesses.
Your answer
Where did the incident occur?
Please be as specific as possible (Ex. Cafeteria near air hockey tables, 7th grade hallway near restroom, etc.)
Your answer
When did the incident occur?
Please be as specific as possible (Ex. Wednesday, September 28th at 8:15am)
Your answer
What happened?
Please describe what happened in detail.
Your answer
Submit
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