School Information
School Name
Incident Information
Where did the incident occur?
In a text message In a voicemail In an e-mail In an instant message In class In front of school In a hallway In the bathroom In the cafeteria In the gym In the locker room In the parking lot After-School Program Off school grounds On the bus On the field Social Media Other
Type
Physical Harassment Sexual Harassment Verbal Harassment Safety Concern and Mental Wellness Other
When did it happen?
Who was bullying, harassing, intimidating or causing harm?
* Include first name, last name and grade if known
Who was the person being harmed, bullied, harassed or intimidated?
Were there any witnesses? Please list their names here.
Describe what happened. Give as much information as you can.
Reporter Information
Are you a
Student Teacher Staff Member Administrator Board Member Volunteer Parent Other
What is your 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.
If you are not a student at this campus and would like someone to contact you, please add your phone number here. (Optional)