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Incident Report Form
If you have information regarding bullying/harassment and would like to report this information anonymously, please fill out the following form to the best of your knowledge and submit.
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* Indicates required question
Target/Victim's Name (first AND last)
*
Your answer
School/Building of Target/Victim
Blue Earth Area Elementary
Blue Earth Area Middle School
Blue Earth Area High School
Student's Name
*
Your answer
Alleged Aggressor's School
Blue Earth Area Elementary (Grades K-5)
Blue Earth Area Middle School (Grades 6-7)
Blue Earth Area High School (Grades 8-12)
Share as many details of the incident as possible.
Provide copies ( ie. letters, photos, texts, posts, etc.) when available.
Your answer
Date of the Incident
*
Your answer
Where did the incident occur?
*
Be specific as possible (ie. on a bus, on the way to/from school, at a school-sponsored event).
Your answer
Please describe the incident, in as much detail as possible, what happened?
*
Your answer
Do you know any of the witnesses involved?
Give as many details as possible.
Your answer
Which statement(s) best describes what happened (choose all that apply)?
Teasing
Intimidation
Physical Violence
Destruction of Property
Social Exclusion
Sexual, Religious, or Racial Harassment
Theft
Spreading False Rumors
Threats
Public Humiliation
Stalking
Cyberstalking/Cyberbullying
Reporter's Name
*
If you prefer to remain anonymous, please state why.
Your answer
Can we use your name in our investigation, if we need to?
*
Choose
YES
NO
Submit
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