Anti-Bullying Reporting

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ANTI-BULLYING/HARASSMENT - VICTIM REPORTING FORM

First name*

Last name*

Please describe what happened, what you saw and heard and how it made you feel*

When did it happen (date & time)*

Where did it happen?*

Who was involoved?*

Do you think anyone else saw or heard it?*

Has anything like this happened before?*

If it has - were the same people involved?*

What do you want to happen now?*

Is there someone in the programme that you comfortable to talk to?*

Signed

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Date*

Day

Month

Year

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