Flasher School Bullying Report Form
Please complete the questions you are comfortable answering or are able to accurately answer. You may choose to include your name at the bottom of the form or submit anonymously. Please note that the District's ability to investigate an anonymous complaint may be limited, and the District prohibits retaliation against anyone who files a bullying report. Click submit at the bottom of the page when you have completed the form.

If you wish, you may request a paper copy of this form by contacting the school. A completed form can be returned to any school staff member or can be placed in the drop box located outside the Counselor's office.
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What day did the incident occur?
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Describe what time(s) of the day the incident happened (before school, morning, lunch, afternoon, after school, 1st period etc.).
Describe where the incident happened (in the classroom, hallway, locker room, bus, etc.).
Describe what happened or is happening. Include as much detail as possible such as the name of the person(s) bullying, the name of the person(s) being bullied, and names of witnesses.
Did the incident result in a physical injury or damage to property? If yes, please describe including the name(s) of person(s) who caused the injury or property damage, the person(s) injured or had their property damaged, and any witnesses.
Has the person(s) being bullied, injured or having damaged property missed school or made changes to their daily routine? If yes, please describe.
Have you told anyone about the bullying, injury, or damaged property? If yes, who did you tell and when?
What is your name, grade/age, and how can you be contacted? (optional)
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