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JICFB-FRM2

Bullying Investigation Report Form

This is a fill-able form. The form fields will expand to include all the words you type. JICFB-FRM2 

Hopkinton Public Schools 
Bullying Investigation Report Form 

INVESTIGATION 

1. Investigator(s):       

2. Interviews: 

☐ Interviewed aggressor(s)/perpetrator(s) Name:       Date:     

☐ Interviewed target Name:            Date:       

☐ Interviewed witness(es) Name:            Date:

                                              Name:             Date:       

                                                   Name:       Date:       

3. Any prior documented incidents by the aggressor/perpetrator: ☐ Yes ☐ No If yes, have incidents involved target or target group previously? ☐ Yes ☐ No Any previous incidents with findings of bullying or retaliation? ☐ Yes ☐ No 

Summary of Investigation (please use additional paper and attach to this document as needed):       

INVESTIGATION CONCLUSIONS 

1. Finding of bullying or retaliation: ☐ Yes ☐ No 

☐ Bullying ☐ Incident documented as       

☐ Retaliation ☐ Discipline referral only       

2. Contacts: 

☐ Target’s parent/guardian Date:       ☐ Aggressor’s/Perpetrator’s parent/guardian Date:       

☐ District Equity Coordinator Date:       

☐ Law Enforcement Date:       

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This is a fill-able form. The form fields will expand to include all the words you type. 

JICFB-FRM2 

3. Action Taken: 

☐ Loss of Privileges ☐ Detention ☐STEP referral 

☐ Suspension ☐ Education ☐ Community Service ☐Other:       

4. Describe Safety Planning:       

Follow-up with Target scheduled for:       

Initial & Date when completed:       

Follow-up with Aggressor/Perpetrator scheduled for:       

Initial & Date when completed:       

☐ Report forwarded to Principal (if principal was not the investigator) Date:      

☐ Report forwarded to Superintendent Date:       

Signature & Title of Investigator: ____________________________ Date:       

Policy Name Revision 6/6/2019 

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