Incident Report Form 2018-2019
If you have information regarding bullying/harassment and would like to report this information anonymously, please fill out the following form to the best of your knowledge and submit.
Target/Victim's Name (first AND last) *
Your answer
School/Building of Target/Victim
Student's Name *
Your answer
Alleged Aggressor's School
Share as many details of the incident as possible.
Provide copies ( ie. letters, photos, texts, posts, etc.) when available.
Your answer
Date of the Incident *
Your answer
Where did the incident occur? *
Be specific as possible (ie. on a bus, on the way to/from school, at a school-sponsored event).
Your answer
Please describe the incident, in as much detail as possible, what happened? *
Your answer
Do you know any of the witnesses involved?
Give as many details as possible.
Your answer
Which statement(s) best describes what happened (choose all that apply)?
Reporter's Name *
If you prefer to remain anonymous, please state why.
Your answer
Can we use your name in our investigation, if we need to? *
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