Bullying Incident Report

I. Introduction

In accordance with 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]

Website: [YOUR COMPANY WEBSITE]

Social Media: [YOUR COMPANY SOCIAL MEDIA]