Bullying/Incident Report
Bullying is an ongoing and deliberate misuse of power in relationships through repeated verbal, physical and/or social behavior that intends to cause physical, social and/or psychological harm. It can involve an individual or a group misusing their power, or perceived power, over one or more persons who feel unable to stop it from happening.

We encourage you to report bullying or other inappropriate behaviors.  Once you complete the form below, you will receive a confirmation that your information has been submitted.  Designated school personnel will be alerted and will respond to your report during regular school hours.  Individuals who submit information will NOT be identified, but may be contacted if there are additional questions about the incident.  If this is an emergency, dial 911.
Sign in to Google to save your progress. Learn more
Email *
Today's Date *
MM
/
DD
/
YYYY
Name of person filing report (You will NOT be identified. This is only in case we have any additional questions.)
 *
What is your relationship to the target (the person who is the victim of the bullying)?
 *
What is the best way to reach you? *
Please share your phone number or other contact information (the best way to reach you).
 *
How do you know about the behavior?
 *
Identify the student(s) Involved in the bullying -The aggressor(s)*


 *
Identify the student(s) who were the target or victim of the bullying*


 *
Bystanders: Did anyone else observe the behavior / incident?  Please name the individual(s)
 *
Do you have any evidence (pictures, videos, notes, texts, etc.) of the incident that you can share with us?  If so, what? *
Date and time of incident (i.e. Thursday, May 1, during 2nd period or right after lunch)*
Your answer

 *
Where did the incident occur? *
Please describe the incident in as much detail as possible*


 *
How often has this happened? *
Have you reported this incident to a school employee previously?  If so, to whom did you report it to? *
I understand school phones, email accounts, and this report will be monitored ONLY during regular school hours on days when school is in session for students. While the average response time should be within one school day, please be aware that it may take two school days for a school official to contact you and follow up. The safety and well-being of students is a top priority for our school.  If you have or know someone is having a life-threatening mental health emergency, call 911.  If you have knowledge of a crime that has been committed, contact 911.  If you have information about a serious mental health related concern, call 988, the Suicide and Crisis Lifeline.
 *
I understand this information will remain confidential. *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Cherokee County Schools. Report Abuse
Google Forms