Bullying Report Form

What is Bullying? Bullying is when someone repeatedly and on purpose says or does mean or hurtful things to another person who has a hard time defending himself or herself.
Your Name:
 
* Relationship to victim:
  Parent
Grandparent
Guardian
Friend
Other
If reported to you by someone else, indicate who:
 
* Date(s) of Incident:
 
* Type of Bullying?
  Verbal
Non-verbal (exclusion, eye-rolling, etc...)
Physical
Cyber-bullying
Other
* Who was Bullied? (Please list first and last names and grade level of all students, if reporting multiple students.)
 
* Who did the Bullying? (Please list first and last names and grade level of all students, if reporting multiple students.)
 
Were there any bystanders? If yes, please list first and last name.
 
Where did it happen?
 
Time of day?
  Morning
Lunch/Recess
Afternoon
Has this happened before?
  NO, this is the first time.
YES, this has happened once before.
This is an ongoing problem.
* Briefly describe the incident:
 
Any other information we need to know?
 
* Required Fields