Anonymous Bullying Incident Report
Please complete the bullying incident report. This report is anonymous. If you have an immediate concern, please contact your school's principal.
Sign in to Google to save your progress. Learn more
I am a: *
During this incident I was a: *
Type the name of the student(s) who are bullying and the school they attend. *
What grade are you in? *
What is the name of the student you would like to report? *
If you do not know the name of the student, please describe the person.
Where did this incident take place? *
Please describe the incident. *
Were there witnesses to this incident? (if known) *
What are the names of the witnesses?
Please rate the severity of this incident. *
1 being minor incident but unacceptable to 5 being major incident
Please describe the frequency with which this type of incident occurs. *
Would you like to speak with a counselor?   *
You must add your name below if you want a counselor to follow up with you.
What is your name (optional)
What else would you like us to know about this incident? (optional)
Clear form
Never submit passwords through Google Forms.
This form was created inside of Forest Ridge School District 142. Report Abuse