Bullying Incident Form
๐——๐—ฒ๐—ณ๐—ถ๐—ป๐—ถ๐˜๐—ถ๐—ผ๐—ป ๐—ผ๐—ณ ๐—•๐˜‚๐—น๐—น๐˜†๐—ถ๐—ป๐—ด:
"Bullying is typically ๐—ฎ ๐—ณ๐—ผ๐—ฟ๐—บ ๐—ผ๐—ณ ๐—ฟ๐—ฒ๐—ฝ๐—ฒ๐—ฎ๐˜๐—ฒ๐—ฑ, ๐—ฝ๐—ฒ๐—ฟ๐˜€๐—ถ๐˜€๐˜๐—ฒ๐—ป๐˜, ๐—ฎ๐—ด๐—ด๐—ฟ๐—ฒ๐˜€๐˜€๐—ถ๐˜ƒ๐—ฒ behaviour that is directed at an individual(s) that is likely to have the effect of: 1) Causing harm, fear or distress to another individual, including physical, psychological, social or academic harm, harm to the individualโ€™s reputation, or harm to the individualโ€™s property, Creating a negative environment at a school for another individual, and; 2) The behaviour occurs in a context where there is a real or perceived power imbalance between the pupil and the individual based on factors such as size, strength, age, intelligence, peer group power, economic status, social status, religion, ethnic origin, sexual orientation, family circumstances, gender, gender identity, gender expression, race, disability or the receipt of special education. Bullying behaviour includes the use of any physical, verbal, electronic, written or other means." ย 

Notice: If you are a parent submitting a form on behalf of your child please mention where applicable. We take all responses very seriously and will investigate what has happened. Please include all information and be detailed as possible without any bias. It is unlawful to include false information and accusations.
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What are the names of the students involved in the incident. Please include any description that will help identify the students. *
Please write your name (name of student and or parent/caregiver)
Phone Number
Email Address
Location where the incident occurred (eg. classroom, playground, gym, washroom, hallway, etc.)
Date of Incident:
MM
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DD
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YYYY
Time of Incident:
Time
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Please describe the details of the incident. *
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