JICFB-FRM1

Bullying Investigation Report Form

 

Policy Homepage

Hopkinton Public Schools

Bullying Prevention & Intervention Report Form

 

1. Name of Person Filing This Report      

Note: Reports may be filed anonymously, but no disciplinary action will be taken against an alleged aggressor/perpetrator solely on the basis of an anonymous report.

 

2. Check whether you are the: ☐ Target of the bullying behavior  ☐ Reporter (not target)

 

3. Check whether you are a: ☐ Student ☐ Staff member (specify role)      

☐ Parent ☐ Administrator ☐ Other (specify)      

 

4. If you are a student, state your school:         Grade:      

 

5. Your contact information, including telephone number:      

 

6. If a staff member, state your work site:      

 

7. Information about the incident

Name of target of bullying behavior:      

Name of the aggressor/perpetrator:      

Date(s) of incident(s)	Time of each	Location of each	Witnesses or others who know about the incident (if any), and their role (student, staff, parent, etc.)

If you have attached additional pages for other incidents, check here: ☐

 

Describe the details of the incident(s), including the names of all who were involved, what each did, and specific words and actions. If you have attached additional sheets, please check here: ☐