Harassment, Intimidation, or Bullying (HIB) Reporting Form 338
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Harassment, Intimidation, or Bullying (HIB) Reporting Form 338
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Elsinboro Township School District *
Individual Completing this Form
If you prefer to remain anonymous, leave this section blank. 
Name of individual completing this form:
Relation to individual involved in the alleged incident of HIB (e.g. parent, guardian, grandparent, etc.)
Phone number:
Email address:
Incident date: *
MM
/
DD
/
YYYY
Incident time: (approximately) *
Time
:
Describe the incident with as much detail as possible. (What was the incident? Who was involved? How  were  you made aware of the incident? What happened at the time of the incident? How did the incident occur? *
Specific incident location(s) (e.g. on the morning school bus, in the science wing hallway, online via social media, etc.)
 *
Name(s) of alleged offender(s): *
Based on your knowledge, select all that apply about the alleged offender(s): *
Required
Name(s) of alleged victim(s): *
Based on your knowledge, select all that apply about the alleged victim(s): *
Required
Witnesses
Complete this section with the names of any potential witnesses.
Student Names: *
Staff Names:
Parent Names:
Other Names: (specify title or position for each)
School Principal/Designee and 
Superintendent Section
Note: The completed form must be kept on file in the school. The principal must promptly submit a copy of this form to the superintendent. 
Utilization of Preliminary Determination Provision
If the school district's policy permits the use of a preliminary determination for reports of HIB, questions 1 and 2 below must be completed on every form. School districts who do not permit the use of preliminary determination for reports of HIB, should leave this section blank.
Question for the School Principal/Designee  
Was a preliminary determination made not to initiate a HIB investigation because the reported incident or complaint is a report outside the scope of the definition of HIB?
Questions for the Superintendent
If the answer to question 1 is yes, will you require the school principal/designee to initiate a HIB investigation based on the scope of the definition of HIB?
If your school district utilizes a tracking system to track alleged incidents of HIB, insert the incident number. 

Incident number:
Submit
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