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ROHS Anonymous Incident Report

This Report will help school staff investigate bullying. You may use initials to identify the individuals involved. Also, please feel free to speak with a counselor or staff member any time if you witness or are the target of any kind of bullying or peer aggression.

* 1. Date(s) or time periods of Incident

* 2. Who is the individual bullying?

* 3. Describe the incident (s)

* 4. Where and when is it happening? (be specific!)

* 5. If there is a specific staff person you'd like to share this report with please leave their name here.

6. What is your name (optional)