RBM Bullying Reporting Form

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Students Involved: Bully (First and Last Name) *

Students Involved: Victim (First and Last Name) *

Students Involved: Witnesses/Bystander/Ally (First and Last Name)

If you feel comfortable sharing - Reporter's Last Name, First Initial (Example: Dober, K)

Date of Incident *

YYYY

Which grade are you in? *

Location of Incident *

Classroom

Hallway

Locker Bay

Cafeteria

Library

Bus

Bathrooms

Google Meet

Google Hangout

Social Media

Type of Bullying *

Direct Bullying (pushing, name-calling, damaging property, threats, punching)

Indirect Bullying (rumors, exclusion, intimidation, gossip)

Cyber-Bulling (social media, instagram, twitter)

Describe the situation *

How often has it occurred in the past week... *

1 to 2 times

3-5 times

other

Did you tell a trusted adult in the building *

Submit

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