Bully Incident Report

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IF YOU ARE IN IMMEDIATE DANGER, CALL 911

Hanh Phan Tilley is committed to providing a safe, comfortable learning environment for all students. Bullying incidents can be reported directly to a staff member at your school. This online form may also be used by Hanh Phan Tilley students to report being bullied or by someone witnessing a student being bullied.

Once submitted, the investigation process will begin within one (1) working day. Keep in mind, this process can only be as thorough as the information provided. Thank you for your assistance in making Hanh Phan Tilley a safe place for all.

What type of incident is this? *

Teasing - Everyone is equally participating. Everyone is having fun, no one is getting hurt.

Conflict - No one is having fun. Two people with equal parts have a fight, argument or disagreement. There is a solution that can usually be agreed upon by both.

Mean Moment - Someone is mean on purpose. It is a reaction to a strong emotion or feeling (mad, hurt, sad). It is an isolated incident - it does not happen regularly.

Bullying - Repeated, unwanted aggressive behavior towards someone. Someone is being hurt on purpose.

Location where the incident occurred *

Bus

Classroom

Hallway

Cafeteria

Playground

Restroom

Other:

Person reporting incident *

Person reporting incident contact #

Person reporting incident contact email

Which best describes you? *

Student

Parent

School Staff

Community Member

Other:

Name(s) of alleged offenders *

Please describe the bullying incident. Try to include as many details as possible. *

Name(s) of any witnesses

Check all bullying types that apply to this incident *

Physical Violence

Name Calling

Hazing

Cyber Bullying

Public Humiliation

Social Exclusion

Threat

Unwanted Physical Contact (pushing, shoving, poking, etc.)

Other:

Required

Thank you for your help.

By completing this form, you are verifying that your statements are true and accurate to the best of your knowledge.
If you have trouble completing this form and would like to speak to someone, contact 559-276-3100.

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