Incident Report
Anonymous reporting of bullying in your school
Reporting Person
This is optional - you do not have to share your name
Your answer
I have reported this event to my school *
I am a *
Type of bullying, harassment, or discrimination: (Check all that apply) *
Required
Name of person bullied: *
This information is required in order to investigate the report.
Your answer
School: *
Name of person DOING the bullying: *
This could be a student or adult.
Your answer
Were you there when the incident occurred? *
List other students or adults who witnessed the incident: *
If no witnesses, enter the word "NONE"
Your answer
Who has been told about the bullying? (Check all that apply): *
If Other, please specify in the area provided.
Where did the bullying occur? (Check all that apply): *
If other, please specify in the area provided.
What date did the bullying occur? *
Your answer
Please describe what happened. *
Include where and when the incident occurred.
Your answer
Link to supporting documentation
Your answer
For Office Use Only:
Administrator Action Taken:
Your answer
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