Report Bullying or Unsafe Behavior
Use this from to report bullying, sexting, substance use/abuse, or any unsafe or unhealthy behavior.
Date(s) of Incident:
Time of Incident:
Location bullying occurred:
Adults made aware of the event:
Check All That Apply
Disregard for another's personal space (Physical or Non/Physical)
Practical jokes, which may result in embarrassment or awkwardness
Name calling (teasing, making fun, etc.)
Insults (put downs)
Insulting "slang" terms regarding (gender, race, ethnicity, etc.)
Inappropriate pictures, drawings, and/or materials
Stealing of money or other possessions
Intentionally excluding others
Description of the incident:
If this report involves social media, keep/save any evidence for the counselor or principal.
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This form was created inside of Shawnee Heights USD #450.