Your Name (required)

Describe what happened/what is happening: (required)

What date did this happen? (required)

What time did this happen? (required)

Was this?: (required)
Before SchoolDuring SchoolAfter SchoolUnsure

Where did it happen?: (required)
In SchoolOut of SchoolOtherunsure

Give more detail about where, e.g. which corridor (required)

Did anyone else witness the bullying? (required)
YesNoUnsure

List any other witnesses (required)

If physically hurt, please explain what happened: (required)

Was anyone's property damaged?: (required)
YesNoUnsure

If property damaged, please explain what happened: (required)

Have you told anyone about the bullying?: (required)
parentBrother/SisterTeacherHead of YearOther Family MemberOther School StaffOther(specify below)

Who have you told about the bullying: (required)

Have you previously filed a bullying report?: (required)
YesNo