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BULLY REPORT FORM

BULLY REPORT Example  Check Status of your Report

A BULLY REPORT can be submitted by a student, classmate, parent, school staff from any school in Canada. Specific details of the incident and people involved is needed - all details will be verified by school staff for accuracy.  The report will be forwarded to the Principal and Counselor of the school.  Photos and Video of an incident can also be submitted.

[False Reporting can be traced to IP Address]

YOUR DETAILS

Who are you?

SCHOOL DETAILS

Name of School:

City / Town:

Province:

DETAILS OF BULLY INCIDENT

Full Name of the Student/Bully: 

Grade of Student:

Date of this Incident:

Specific details of the Incident (Tell the whole story of what happened)

On a scale of 1 to 10, how bad is this?

ADDITIONAL DETAILS

Where did it happen?

What time did it happen?

How many people saw this happen?

Who have you told?

How long has this been going on?

PROOF OF SCHOOL ASSOCIATION

What is the name of your P.E. teacher at the school?

 
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