Bullying Incident Reporting Form

A person is bullied when he or she is exposed, repeatedly and over time, to negative actions on the part of one or more other persons. He or she has difficulty defending himself or herself against these actions and persons. In order to be considered bullying, the behavior must include an imbalance of power. Types of bullying may iinclude actions such as making threats, spreading rumors, attacking someone physically or verbally, and excluding someone from a group on purpose.

Bullying Incident Reporting Form
Please complete this section to assist us in following up with this incident
Your Name:

Select whether your are the:

Select whether you ar a:

Your Phone Number: 
Your Email Address: 
Please fill out the following in as much detail as possible.
Indicate the name(s) of the alleged victim(s). 
What school does the alleged victim(s) attend?
What grade is the alleged victim(s) in?
Indicate the name(s) of the alleged bully(ies) of the incident. 
What school does tshe alleged bully(ies) attend?
What grade is the alleged bully(ies) in?
List names of any witnesses or bystanders. 
When did the incident occur? 
Where did the incident occure? 
Describe the incident in as much detail as possible. 
Are there school staff members that are already aware of this?


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