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GMS Anonymous Incident Report
This anonymous form can be used by students, parents, and community members to share concerns. The information will be shared with school administrators.
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* Indicates required question
Date of incident
MM
/
DD
/
YYYY
Location:
*
Playground area
Cafeteria
Gym
Bus
In a classroom - specify which one below
Online
Other:
Specific location or if online please give details:
Your answer
Please describe, in as much detail as possible, what you saw and heard:
*
Your answer
Were there any bystanders or witnesses?
*
Yes
No
Not sure
Please identify if you witnessed this behavior as a bystander OR if you were the target (victim).
*
Bystander
Target
Neither (heard it from someone else)
What is the target's name?
*
Your answer
What is the grade of the target?
*
Your answer
What is the offender's name?
*
Your answer
What is the grade of the offender?
*
Your answer
If you would like a school administrator to contact you, please include your name here (optional)
Your answer
Is there anything else that you think would be important for us to know?
Your answer
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