HIB 338 Form Harassment, Intimidation, or Bullying (HIB) Reporting Form 2023-2024 School Year

HIB 338 Form Harassment, Intimidation, or Bullying (HIB) Reporting Form 2023-2024 School Year
To Be Completed by Families / Caregivers
To be filled out by Principal or Designee
Date and Time Received

MonthDayYear
Date
Incident # (optional)
This form should be used by parents or guardians to report allegations of HIB. A written statement from the alleged victim or other evidence may be attached to the back of this HIB 338 Form (e.g., screenshot, text thread, etcOnce the form is received by the school, the principal is responsible for implementing the school district’s policy and procedures. An investigation shall be completed as soon as possible, but not later than 10 school days from the date of the written report of the incident. Should you have any questions about the investigation, please contact the school principal.
Directions
Complete the form below to provide detailed information of the alleged HIB incident. If some fields are not applicable or if you are uncertain of the response, you may skip those fields. This form may be submitted anonymously.
School Information
School District
School
Individual Completing Form
If you prefer to remain anonymous, leave this section blank. Individuals filling out this HIB 338 Form as an anonymous reporter may consider adding their name as a witness.
Name of individual completing this form
Relation to individual involved in alleged incident of HIB
e.g., parent, guardian, grandparent, etc
Phone number
Format: (000) 000-0000.
Email address
example@example.com
Incident Information
Incident date (mm/dd/yyyy)

MonthDayYear
Date
Approximate time of the incident
Describe the incident with as much detail as possible. (What was the incident? Who was involved in the incident? How you were made aware of the incident? What happened at the time of the incident? How did the incident occur?)
Specific incident locations e.g., on the morning school bus, in the science wing hallway, online via social media, etc
Alleged Offender(s)
Name(s) of alleged offender(s)
Alleged offender(s) attends the above-named school.Alleged offender(s) attends another school.Alleged offender(s) works for the school/school district.Alleged offender(s) does not work for the school/school district.
Alleged Victim(s)
Name(s) of alleged victim(s)
Victim(s) attends the above-named school.Victim(s) attends another school.
Witnesses
Complete this section with the names of any potential witnesses.
Student Names
Parent Names
Other Names (specify title or position for each)
Other Names (specify title or position for each)
Signature
Signature of Person Completing this HIB 338 Form
Date

MonthDayYear
Date
Should be Empty:

HIB 338 Form Harassment, Intimidation, or Bullying (HIB) Reporting Form 2023-2024 School Year

To Be Completed by Families / Caregivers

Directions

School Information

Individual Completing Form

Incident Information

Alleged Offender(s)

Alleged Victim(s)

Witnesses

Signature