JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Orcas Island School District: Bullying and Harassment Reporting Online Form for Students and Staff. Distrito Escolar de Orcas Island: Formulario en línea para informes de acoso y acoso para estudiantes y personal.
Please use this form to report incidents of bullying and harassment. More information regarding OISD Bullying and Harassment policies can be found in our school handbooks or click here:
Link to OISD Policies to prevent harassment, intimidation and bullying-
A paper version of this form is available at your school office or in your school handbook.
Utilice este formulario para denunciar incidentes de intimidación y acoso. Puede encontrar más información sobre las políticas de intimidación y acoso de OISD en nuestros manuales escolares o haga clic aquí:
Enlace a las Políticas de OISD para prevenir el acoso, la intimidación y la intimidación
: una versión impresa de este formulario está disponible en la oficina de su escuela o en el manual de su escuela.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Your Name, Last name first please:
Su nombre, apellido primero por favor:
This is an optional question (you may remain anonymous)
Esta es una pregunta opcional (puede permanecer en el anonimato)
Your answer
Name of person targeted:
Nombre de la persona objetivo:
*
Your answer
Details (if known):
Detalles (si se conocen):
Your answer
Your email address:
Su dirección de correo electrónico:
(optional)
(opcional)
Your answer
Your phone number:
Su número de teléfono:
(optional)
(opcional)
Your answer
Today's Date:
Fecha:
*
Your answer
Name of authority (adult) you've already contacted (if any - you may also reply none):
Nombre de la autoridad (adulto) con la que ya te has puesto en contacto (si la hay, también puedes responder ninguna):
*
Your answer
Name(s) of bullies or harasser (if known; or, you may reply "none", or "I don't know who they were"):
Nombre(s) de los agresores o acosadores (si los conoce; o puede responder "ninguno" o "no sé quiénes fueron"):
*
Your answer
On what dates did this incident(s) happen (if known):
En qué fechas ocurrieron estos incidentes (si se conocen):
*
Your answer
Where did this (or these) incident(s) happen?
¿Dónde ocurrió este (o estos) incidente(s)?
*
Choose all that apply -
Elija todos los que correspondan
Classroom
Hallway
Restroom
Playground
Locker Room
Lunchroom
Sports field
Parking Lot
School Bus
Internet
Cellphone
During a school activity
Off school grounds
On the way to/from school
Staff Lounge
Other:
Required
If Other was chosen from the list above, please describe where the incident happened here:
Si eligió Otro de la lista anterior, describa dónde ocurrió el incidente aquí:
Your answer
Please check the box that best describes what the bully or harasser did
.
Marque la casilla que mejor describa lo que hizo el agresor o acosador
.
*
(Please choose all that apply)
Hitting, kicking, shoving, spitting, hair pulling or throwing something at the person
Getting another person to hit or harm the person.
Teasing, name calling, making critical remarks or threatening in person, by phone, by email, etc.
Putting the person down and making them a target of jokes.
Make rude or threatening gestures.
Excluding or rejecting the student or adult.
Making the person fearful, demanding money, or exploiting.
Spreading harmful rumors or gossip
Cyberbullying (bullying by calling, texting, emailing, web posting, etc).
Demands for sexual favors in exchange for preferential treatment or something of value.
Statements implying that a person will lose something if he or she does not submit to a sexual request.
Threat to penalize for refusing to submit to a sexual advance, or the promise of a benefit for complying.
Unwelcome, offensive or inappropriate sexually suggestive remarks comments, gestures, or jokes; or remarks of a sexual nature about a person's appearance, gender or conduct.
Derogatory sexual terms for a person used.
Standing too close, inappropriately touching, cornering or stalking a person.
Displaying offensive or inappropriate sexual illustrations on school property
Other:
Required
If other was chosen from the list above, please describe here:
describa dónde ocurrió el incidente aquí:
Your answer
Why do you think the harassment (sexual or otherwise), intimidation or bullying occurred?
¿Por qué cree que ocurrió el acoso (sexual o de otro tipo), la intimidación o el acoso?
*
Your answer
Were there any witnesses?:
¿Hubo testigos?:
*
Yes/ Si
No
If you answered yes to the previous question, please provide witness (es) name(s) if known:
Si respondió afirmativamente a la pregunta anterior, proporcione los nombres de los testigos, si los conoce:
Your answer
Did a physical injury result from this incident?
¿Se produjo una lesión física como resultado de este incidente?
*
Yes / Si
No
If an injury occurred, please describe:
Si se produjo una lesión, por favor describa:
Your answer
Was the target absent from school (student) or their job (staff member) as a result of this incident ?:
¿El objetivo estuvo ausente de la escuela (estudiante) o de su trabajo (miembro del personal) como resultado de este incidente? :
*
Yes
No
If absent from school or your school job as a result, please describe:
Si se ausentó de la escuela o de su trabajo escolar como resultado, describa:
Your answer
Is there any additional information you would like to provide?
¿Hay alguna información adicional que le gustaría proporcionar?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Orcas Island School District.
Report Abuse
Forms
