Bully Report Form

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Bully Report Form

This form can be used to fill out if you or someone you know is being bullied and you do not have the opportunity to report the bullying in person to the school principal, counselor, or designated teacher. Forms can be dropped off to any staff member, the school office, or dropped off in the building's reporting box.

Bullying is an aggressive behavior among school aged children that involves a real or perceived power imbalance. The behavior is repeated and unwanted.

Reporter's Name (if you wish to share)

Reporter's Grade

Who is the alleged target? (Name and Grade)

Who is the alleged bully? (Name and Grade)

Name and grade of witnesses or bystanders?

Where did the incident occur?

Bus

Hallway

Playground

Classroom

Bathroom

Lunchtime

Other:

Was the alleged bullying physical, verbal, relational, or cyber.

Physical - hurting another person's belongings or body

Verbal- saying or writing mean things

Relational- hurting someone's reputation or relationships

Cyber- using technology to engage in bullying

Clear selection

Please describe the incident.

Submit

Clear form

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This form was created inside of Germantown Hills SD 69. Report Abuse

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