Incident Report Form

Incident Report Form

Please complete this form, responding only to the questions that you feel comfortable answering and are able to accurately answer. You may choose to include your name at the bottom of the form or may submit it anonymously. Please note that 7Attitudes ability to investigate an anonymous complaint may be limited, and 7Attitudes prohibits retaliation against anyone who files a bullying report. The data submitted here is entirely voluntary on your part and your identity will be confidential.
Bullying, harassment and intimidation of fellow dancers will not be tolerated.

Any such behaviour on the part of a student may result in dismissal from the class and ultimately in suspension from the program.
Date of Incident

MonthDayYear
Date
When did the Incident happen?

Before DanceDuring DanceAfter DanceUnsure
If you know more specifically about what time the incident occurred, please enter it below

Hour Minutes

AM/PM Option
Where did the Incident happen?

In classIn the changeroomAt a dance eventOnlineOther
If Other please let us know where:
Describe what happened or what is happening.
Who was committing the bullying? (if you are unsure of the name, please describe him/her to the best of your ability.
Who was the victim of the bullying? (if you are unsure of the name, please describe him/her to the best of your ability.
Did anyone else witness the bullying?

YesNoUnsure
If yes, please list the name(s) of any witnesses.
Were you or others physically hurt?

YesNoUnsure
If yes, please explain
Were the damage to anyone's physcial property:

YesNoUnsure
Please explain whose property and what specifically was damaged
Have you or the victim missed any dance or made any changes to your daily routine as a result of the incident(s)? (If yes, please explain)

YesNoUnsure
Have you told anyone else about the bullying? If yes, please tell us whom you've told.
Your Name (Optional) -- Please understand that a complaint filed anonymously may limit our ability to investigate and respond to the alleged violations.
Your age (optional)
Please let us know how you would like us to respond to your incident

Just letting us knowWanting to get parents involvedLooking for an immediate resolution
Notice

We take all reports of bullying very seriously. The data submitted here is entirely voluntary on your part and your identity will be confidential.
Bullying, harassment and intimidation of fellow dancers or parents will not be tolerated. Any such behaviour on the part of a student may result in dismissal from the class and ultimately in suspension from the studio.
Should be Empty: