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CM Jr-Sr High Incident/Bullying Online Form 23-24
This is our Jr-Sr High incident and bullying reporting online system. IF SOMEONE IS IN IMMEDIATE DANGER OR AT RISK OF INJURY PLEASE CONTACT AN ADULT RIGHT AWAY OR CALL 911 FOR AN EMERGENCY. Do not fill out this form if someone is in immediate danger.
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* Indicates required question
Name of Reporter OPTIONAL (so we can ask further questions if needed - please leave a phone number or email if you are not a student and are okay with us contacting you. )
Your answer
Your Grade/Relation
*
Choose
5
6
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9
10
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12
Parent/Guardian
Community Member
Elementary Student
Staff Member
Anonymous
Are you reporting a conflict situation, bullying, harassment, or potential safety concern?
*
Conflict - 2 or more people having a disagreement, argument, or are having a difference of opinions/interests.
Bullying - Bullying is when someone repeatedly and on purpose says or does mean or hurtful things to another person. The person has already asked the student to stop and no change of behavior has occurred.
Potential Safety Concern - A student is doing questionable or potentially harmful things and they should likely seek help so the situation doesn't turn dangerous.
Harassing/Mean Comments - Instances of being mean that have gone too far
Date of Report
*
MM
/
DD
/
YYYY
Name and grade of person(s) involved in the conflict, harassment/bullying, or safety concern.
*
Your answer
Report details (including summary of the situation, dates, and place(s) which it occurred)
*
Your answer
OPTIONAL - Other details (including quotes/examples):
Your answer
Witnesses (if any)
Your answer
I agree that all of the above information is accurate and true to the best of my knowledge.
*
Yes
No
Required
Disclaimer: Filling out this form does not guarantee disciplinary action or immediate changes in behavior. This form is used as an early warning system and to provide an anonymous reporting option for those that may not feel comfortable reporting directly to a staff member. Any personally identifying information will be left out of conversations/interventions unless we have your consent to share. Thank you for your time.
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