B M Hanson Elementary Bullying Report Form

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B M Hanson Bullying Report Form

The person reporting the bullying incident has the option of including his or her name on
this form OR submitting the form anonymously. Please note, anonymous reports are more difficult to investigate.
Please answer all sections that apply and return the form to the principal/supervisor at the
building where the bullying event occurred. Thank you for helping to keep our schools safe!

*Bullying is unwanted, aggressive behavior among school-aged children that involves a real or perceived power imbalance. The behavior is repeated, or has the potential to be repeated, over time. Bullying includes actions such as making threats, spreading rumors, attacking someone physically or verbally, and excluding someone from a group on purpose.

Your name (optional)

Date(s) of Incident *

Location of the incident *

classroom

hallway

locker-room

lunchroom

bus

other

Name/grade of the person who was the victim *

Describe what took place, such as the type of bullying (verbal, written, online). *

Is there any other important information that you would like to share?

Name/names of anyone else who witnessed the incident (optional).

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