Report Bullying

Report Bullying

Does what happened fit all three parts of bullying?
1. It is repeated?
2. There is an imbalance of power.
3. The person is being mean on purpose and wants to do harm.

Date: 

Time: 

Grade: 

Teacher:

Name of targeted student: 

What happened? 

What was happening before the problem? 

When did it happen? 

Where did it happen?
 Bus  Playground  Hallway  Bathroom  Cafeteria  Classroom

Other: 

Who was bullying? 

Was an adult told? 

If so, who was told? 

What did the adult say the student should do? 

Did the student do what the adult said? * Yes No

If so, did it help? * Yes  No

Names of others who saw this happening: 



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