Report Bullying 18-19
Bernal Intermediate School
Incident Information
Where did the incident occur? *
Type of incident *
What day did it happen? *
MM
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DD
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YYYY
Approximately what time did it happen?
Time
:
Who was bullying, harassing, intimidating or causing harm? (Include first name, last name and grade if known)
Your answer
Who was the person being harmed, bullied, harassed or intimidated? (Include first name, last name and grade if known)
Your answer
Were there any witnesses? Please list their names here.
Your answer
Describe what happened. Give as much information as you can. *
Your answer
Reporter Information
Are you a: *
What is your first and last name? (Optional) Please note: Anonymous reports are accepted however they must provide sufficient evidence to justify the commencement of an investigation. Formal disciplinary action may not be based solely on an anonymous complaint.
Your answer
If you are not a student at this campus and would like someone to contact you, please add your phone number here. (Optional)
Your answer
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