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