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  • Conflict Bully Report Form

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    This conflict/bullying report form from Whitford Middle School allows students to report incidents of bullying according to the school's zero tolerance policy. It prompts students to determine if the incident was normal conflict or bullying based on power imbalance and frequency. Students then check off the type of aggression and provide details such as dates, names of those involved, location, and a description of the incident. Space is included for witnesses and the actions taken by staff.

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    This conflict/bullying report form from Whitford Middle School allows students to report incidents of bullying according to the school's zero tolerance policy. It prompts students to determine if the incident was normal conflict or bullying based on power imbalance and frequency. Students then check off the type of aggression and provide details such as dates, names of those involved, location, and a description of the incident. Space is included for witnesses and the actions taken by staff.

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    © All Rights Reserved
    Téléchargez comme DOCX, PDF, TXT ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    57 vues2 pages

    Conflict Bully Report Form

    Transféré par

    api-425694415
    This conflict/bullying report form from Whitford Middle School allows students to report incidents of bullying according to the school's zero tolerance policy. It prompts students to determine if the incident was normal conflict or bullying based on power imbalance and frequency. Students then check off the type of aggression and provide details such as dates, names of those involved, location, and a description of the incident. Space is included for witnesses and the actions taken by staff.

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme DOCX, PDF, TXT ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    sur 2

    Conflict/Bullying Report Form

    Whitford Middle School


    Whitford Middle School has a Zero Tolerance policy regarding bullying. If you experience or see any type of
    bullying, you must report it to a staff member in a timely manner.

    Determine if the incident is normal conflict or bullying


    Check what applies
    Normal conflict bullying
     Equal Power/friends  Imbalance of power/not friends
     Happened once/occasionally  Happens Repeatedly

    Type of Incident (Check what applies)


     Physical Aggression
     Social Aggression (spreading rumors, using racial slurs, or exclusion from groups)
     Verbal aggression/name calling
     Intimidation/threats
     Written/on-line aggression
    Date(s) of incident(s): ________________________ Today’s date: _______________________

    Your name: ____________________________________________________________________

    Name of target: ________________________________________________________________

    Name of participants: ____________________________________________________________

    Location of incident: ____________________________________________________________

    Describe incident:
    __________________________________________________________________________________________

    __________________________________________________________________________________________

    __________________________________________________________________________________________

    __________________________________________________________________________________________

    What did you do?


    __________________________________________________________________________________________

    __________________________________________________________________________________________

    Other Witnesses (Names):


    __________________________________________________________________________________________
    Office Use Only
    Investigated by: Assistant Principal ______ Principal ______ Counselor ______

    Date: ___________

    Action Taken:
    ________________________________________________________________________________________

    ________________________________________________________________________________________

    ________________________________________________________________________________________

    ________________________________________________________________________________________

    Parents Contacted: ______ Date _______

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