Bully Reporting Form

Bully Reporting Form
Campus:
 
Date of incident:
(mm/dd/yyyy)
 
Date of report:
(mm/dd/yyyy)
 
Person bullying:
 
Grade of person bullying:
 
Person being bullied:
 
Grade of person being bullied:
 
List any bystanders/witnesses:
 
Type of bullying:
Physical
Emotional/Social
Damage to Property
Cyber
 
  
 
Where did the incident take place?
Restroom
Bus
Bus Stop
On the way to or from school
Locker Room
Parking Lot
Internet
Cafeteria
Cellphone
Playground
Hallway
Classroom
School Event
Classroom/Gym
Other
 
  
 
If other selected, please list location:
 
When did it take place?
 
Describe what happened. Give as many details as possible.
 
List evidence of bullying if any (letters, photos, text messages, etc.)
 
 
Person making report:
 


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