Free Bullying Incident Report Template
Bullying Incident Report
I. Introduction
Under our school's policies and procedures, this Bullying Incident Report aims to comprehensively document and address instances of bullying within our educational institution. It is imperative that all incidents of bullying are promptly reported and appropriately addressed to ensure the safety and well-being of our students.
II. Incident Details
|
Date |
Time |
Location |
|---|---|---|
|
2054-05-30 |
10:30 AM |
[YOUR COMPANY NAME], [YOUR COMPANY ADDRESS] |
III. Parties Involved
A. Bully
Name: Jason Smith
Grade/Class: 5th Grade, Class A
Description (if known): Tall, blonde hair, wears glasses
B. Victim
Name: Emily Jones
Grade/Class: 5th Grade, Class A
Description (if known): Petite, brown hair, braces
C. Witnesses
Names:
-
Sarah Adams
-
Michael Brown
Grade/Class: 5th Grade, Class A
Relationship to Incident: Classmates
IV. Description of the Incident
During recess, Jason Smith pushed Emily Jones to the ground and called her hurtful names. Witnesses report that this behavior has been ongoing for several weeks.
V. Witness Statements
-
Sarah Adams: "I saw Jason push Emily and call her names. It's been happening a lot lately."
-
Michael Brown: "I heard Jason say mean things to Emily before pushing her. It's not right."
VI. Actions Taken
-
Separated Jason and Emily immediately.
-
Provided emotional support to Emily.
-
Discussed the incident with Jason and explained the consequences of his actions.
VII. Follow-up Measures
-
Scheduled a meeting with Jason's parents to discuss his behavior.
-
Implementing a peer mediation program in the classroom to promote positive interactions among students.
VIII. Signature and Date
Reported by: [YOUR NAME], Teacher
Date: 2054-05-30
School: [YOUR COMPANY NAME]
Address: [YOUR COMPANY ADDRESS]
Contact Number: [YOUR COMPANY NUMBER]
