Bullying Report Form

I am a:

I am a:

Your Name (Optional)

If a pupil, what year are you in?

What is the name of the pupil you would like to report?

Where does/did the bullying take place?

Please share some details:

Are there any witnesses? It would be helpful if you could provide their names.

Please rate the severity of the bullying from your point of view.

How do you feel about what has been happening?

Would you like to speak to a counsellor?

Is there anything else you would like us to know about the situation? How can we help?