FMS Bullying Report Form 2018-2019
Student responses will be sent to the principals and counseling office. You are not required to include names, but knowing the name(s) of the people involved helps us investigate as thoroughly as possible. So, please include this information if you feel comfortable doing so.
Date of Event
Location of Incident
Use "Other" if you have an exact location.
In the classroom
In the hallways
In the bathrooms
During outside "Panther Time"
In the cafeteria
Time of Event
If you do not know the exact time of the incident, pick an approximate time
I am a:
Person Being Bullied
If you are a student, select your current grade.
I am not a student.
Your Full Name (optional)
Witnesses or Bystanders:
Who else saw this happen? If no one else observed, it is okay to leave this blank.
Name(s) of student(s) being bullied or targeted:
Grade AND/OR Class
Name(s) of student(s) bullying:
Describe the Incident:
Describe what happened. Include the names of people involved, if you know them. Also include what each person said and did.
How many times has the incident happened?
Have you told anyone about this before?
If so, who?
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