HIB Incident Reporting Form
This form (HIB 338 Form) should be used by parents or guardians to report allegations of HIB.  Once the form is received by the school, the principal is responsible for implementing the school district's policy and procedures.  An investigation shall be completed as soon as possible, but not later than 10 school days from the date of the written report of the incident.  Should you have any question about the investigation, please contact the school principal.

DIRECTIONS
Complete the form to provide detailed informations of the alleged HIB incident.  If some fields are not applicable or if you are uncertain of the response, you may skip those fields.  This form may be submitted anonymously.
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Name of individual completing this form:
Relation to individual involved in alleged incident of HIB (e.g., parent, guardian, grandparent, etc.):
Your Phone Number
Your Email:
Incident date (mm/dd/yy): *
MM
/
DD
/
YYYY
Approximate time of the incident: *
Time
:
Describe the incident with as much detail as possible.  (What was the incident? Who was involved in the incident?  How you were made aware of the incident?  What happened at the time of the incident?  How did the incident occur?) *
Specific incident locations(s)(e.g., on the  morning school bus, in the science wing hallway, online via social media, etc.) *
Name(s) of alleged offender(s): *
Based on your knowledge, select all that apply about the alleged offender(s): *
Required
Name(s) of alleged victim(s): *
Based on your knowledge, select all that apply about the alleged victim(s): *
Required
Name any potential student witnesses: *
Name any potential staff witnesses: *
Name any potential parent witnesses: *
Name any other potential witnesses (specify title or position for each): *
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