Bullying/Harassment Incident Report - Wyoming Area School District
Bullying/Harassment Incident Report - Wyoming Area School District
Bullying/Harassment Incident Report - Wyoming Area School District
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6. What did the alleged offender(s) say or do? ________________________________________<br />
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7. Did a physical injury result from this incident?<br />
_____ No _____ Yes, but it did not require medical attention<br />
_____ Yes, and it did require medical attention<br />
8. Were the police notified?<br />
_____ Yes _____ No<br />
9. Was the student victim absent from school as a result of the incident?<br />
_____ Yes _____ No<br />
If yes, how many days was the student absent as a result of the incident? _____________<br />
10. Additional information you’d like to provide:<br />
______________________________________________________________________________<br />
______________________________________________________________________________<br />
______________________________________________________________________________<br />
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Please submit this form to an administrator or school counselor.<br />
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Signature<br />
______________<br />
Date
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