HIB 338 Form Harassment, Intimidation, or Bullying (HIB) Reporting Form 2023-24 School Year
This form should be used by parents, guardians, or anyone reporting 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 questions about the investigation, please contact the school principal. 

Directions 

Complete the form below to provide detailed information 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.
Sign in to Google to save your progress. Learn more
School Information 
Please provide school information by answering the questions below. 
School *
Individual Completing Form
If you prefer to remain anonymous, leave this section blank. Individuals filling out this HIB 338 Form as an anonymous reporter may consider adding their name as a witness.
Name of Individual completing this form:
Relationship to individual involved in allege incident of HIB (e.g., parent, guardian, grandparent, etc.):
Phone number
Email Address
Incident Information
Please answer the questions below to provide a description of the incident.
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 location(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)
Name(s) of alleged victim(s) *
Based on you knowledge, select all that apply about the alleged victim(s) *
Required
Witnesses
Complete this section with the names of any potential witnesses.
Student Name(s):
Staff Name(s):
Parent Name(s):
Other Name(s) (specify title or position for each)
Typing your name here will count as a signature of the person completing this HIB 338 form.
Date: *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Sparta Township Public Schools. Report Abuse
Google Forms