GFPS Staff Bullying Report Form

Instructions: Please respond only to the questions that you feel comfortable answering and are able to accurately answer. You may choose to add your name at the end of the form or may submit it anonymously. Please note that the district's ability to investigate an anonymous complaint may be limited, and the District prohibits retaliation against anyone who files a bullying report.

Describe what happened/what is happening:

When did it happen?

Date

Time

Where did it happen?

Add any details for the instances noted above.

Who was committing the bullying (if you're unsure of the bully's name(s) describe them)?

Who was the victim of the bullying (if you're unsure of their name, describe them)?

Did anyone else witness the bullying?

Please list names of witnesses.

Were you or others physically hurt?

Please explain who was physically hurt.

Was there damage to anyone's personal property?

Please describe the damage to personal property.

Have you or the victim missed any school or made any changes to your daily routine as a result of the incident(s)?

Please describe their change in routine.

Have you told anyone about the bullying?

Have you previously filed a bullying report (this information is used to determine if retaliation is occurring)?

Your name

First NameLast Name

Your grade

Your age

Your school

How may we contact you? (phone number or email address)

Student Bullying Report Form