Online 7H Report Form

I am a .....

Name (optional)

I was a target of or witnessed...

name calling
pantsing
sexual harassment
mean notes
spreading rumors
pushing/tripping/muffing
book checking
social isolation
inappropriate touching
racist comments
threatening
swearing at me/another target
throwing objects at me/target
vandalism
smacking/punching/slapping
staring me/target down
cyberbullying
slamming locker/spinning lock
using rubber band hornets
poking/pinching
making fun of religious beliefs
making fun of size/looks/etc.
theft/”forcing"someone to buy food

Who was the target?

Who was/were the student/s engaging in aggressive behavior?

Where and When?

Who else witnessed this?

What did you do?

How did you feel?

As the witness, could you do anything to help?

What follow up action would you like to the BJHS staff to consider?

talk to me as soon as possible
talk with the target
supervise problem area
talk to me when you have time
interview witnesses
talk to aggressor
hold a class meeting
watch target
check camera
I want to see counselor/principal

Any other comments?

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