Harassment Incident Reporting Form
IMPORTANT: Incidents reported through this system will be reviewed by staff during school hours and is strictly for the use of Lake Bluff students and parents.

DO NOT USE THIS SYSTEM TO REPORT EMERGENCIES THAT REQUIRE IMMEDIATE ATTENTION. Instead, call 911.

If you need additional support, you may also contact the Lake County Crisis Center at 847-377-8088. Additional help may be available through the Text-a-Tip line. Text 847Help to 844-823-5323 to be connected to a crisis counselor 24-hours a day, 7 days, week.

This incident form should be filled out when you have a concern about something that happened to you or someone you know. Situations such as harassment, intimidation, depression, or someone hurting themselves are very serious and should be addressed by someone who can help. You are not required to use your name, but please do if you would like someone to follow up with you. We will do our best to handle each situation quickly, sensitively, and confidentially.

Thank you for being honest and serious with your report.

First Name
Your answer
Last Name
Your answer
Role *
School *
Describe what happened *
Your answer
When did this happen? *
Your answer
Where did this happen? *
Your answer
Who was involved in the situation?
Your answer
Did anyone else see what happened?
If Yes, who else saw what happened?
Your answer
Describe whether this was a one-time incident or part of an ongoing problem.
Your answer
Describe whether this was a one-time incident or part of an ongoing problem.
Your answer
What sort of help would you like with this situation?
Your answer
Is there anything else that we should know about this situation?
Your answer
Submit
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This form was created inside of Lake Bluff School District 65.