HES Anonymous Bullying Incident Report

Anonymous Bullying Incident Report

The District encourages the reporting of bullying incidents to school administrators whenever possible. In cases where confidentiality is a concern, an anonymous incident report may be filled out below.

All forms submitted through these pages remain completely anonymous.

Date of Report*

Answer Required

Name(s) of alleged target(s) of bullying*

Answer Required

Name(s) of alleged aggressor(s)*

Answer Required

Name(s) of witness(es)*

Answer Required

When did the incident occur?*

Answer Required

What time did the incident occur?*

Answer Required

Give a brief description of the incident(s) and/or concerns.*

Answer Required

Did a physical injury result?*

Answer Required

Yes, but it did not require attention

Yes, and it required medical attention

Do you know of other incidents of bullying directed at this student?*

Answer Required

Yes

Other:

Name of person reporting incident(s)

(You may report anonymously)

Answer Required

Relationship to Student

(Optional)

Answer Required

Email Address

(Optional)

Answer Required

Please fix the highlighted areas below before submitting.

HES Anonymous Bullying Incident Report