CIK Record of Bullying Behaviour
Please remember that you can contact any member of staff if you have any concerns regarding bullying or wish to report a bullying incident.

You do not have to fill this form out.

If you do fill out this form, we will discuss all of the information you give below with you in relation to all incidents before we proceed with any actions.

This information provided in this form will be treated in confidence and will only be discussed with those deemed necessary by school management.

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1. Your email address *
2. Name of student/s being bullied *
3. Year group they are in *
4. Name(s) & class(es) of students engaged in bullying behaviour
 *
5. Source of Bullying Concern (choose all that apply)
 *
Required
6.  Location of bullying incidents (tick all that apply) *
Required
7.  Name of person reporting bullying incident *
8.  Type of bullying behaviour *
Required
9.  Where behaviour is identity based bullying, indicate the relevant category *
Required
10.  Please give a brief description of the bullying incident & its impact *
11.  Details of action taken (please answer if you have taken any action) *
12. Anything else you wish to add to the above?
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