Auburn Public Schools Bullying Incident Form

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CAUTION ABOUT SUBMITTING FALSE REPORTS: Submitting a false report of bullying against someone is prohibited and may require intervention from school administration and/or Auburn Police.

The person completing this form is the: *

Target of the behavior

Reporter of the behavior (not the target)

Date of Incident: *

YYYY

Time of Incident: *

Time

Location of Incident: *

Incident Description: *

Please provide the name(s) of potential witnesses (people who saw the incident or may have information about it):

To your best knowledge, has there been a previous incident between these students? *

Yes

Not Sure

Are there any immediate safety concerns? *

Yes

Not Sure

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