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:
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
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
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]
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