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Bullying Incident Report
Bullying Incident Report
Today's Date
Answer Required
Date of incident
*
Answer Required
Time of incident
*
Answer Required
Where did the incident take place?
*
Answer Required
On the way to school
In the classroom
In the hallway
In the lunchroom
On the bus
In the restroom
In the locker room
In the parking lot
On the Internet
At an afterschool program
At a school sponsored event
Other:
If the event happened at school, which campus?
Answer Required
SGS Ranch Campus Pk-2nd grade
SGS Elementary 3rd grade -8th grade
SG Academy High School 9th grade - 12th grade
Who was the person(s) engaged in bullying? What grade(s) are they in?
Answer Required
Who was involved?
Answer Required
Who was being bullied? What grade are they in?(All names will be kept confidential)
Answer Required
What type of bullying occurred?
Answer Required
Physical
Emotional
Relational
Cyber (Cell phone, text, email, Snapchat, Twitter, Facebook)
Please describe and explain the incident
*
Answer Required
Confirmation Email
Confirmation Email
Email Required
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