Bullying and Harassment Report Form

Be advised, if a report is made anonymously it will limit our investigation process and we will be unable to follow up with the person making the report. Students found responsible for deliberately making false reports may be subject to a full range of disciplinary consequences as publicized in student handbooks.

Please know that these forms are not monitored 24/7, and it may take several business days for us to respond. If you or someone else needs immediate help, please call or text 988, Suicide & Crisis Lifeline, contact the Ohio School Safety Center, or call 911.

Name of Reporter/Person Filing the Report

Optional: If a report is made anonymously it will limit our investigation process and we will be unable to follow up with the person making the report.

Email of person reporting

Optional

Are you the target of the behavior?

Yes

Are you a:

Student

Staff Member

Parent

Other

Your School/Building

Information about the Incident

Name of target (of behavior)(Required)

First Last

Name of Aggressor (person who engaged in the behavior)(Required)

First Last

Date of Incident(Required)

Time of Incident(Required)

Hour

Minute

Location of Incident(Required)

Witnesses

List people who saw the incident or have information about it.

Witness One

Witness Two

Witness Three

Incident Details

Detail of Events(Required)

Describe the detail of the incident (including names of people involved, what occurred, and what each person did and said, including specific words used).