Bullying Prevention Report Form Page 2
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3Physical Evidence:
(Check all that apply)
Graffiti
Notes
Email
Websites
Video/Audio Tape
Other: ______________________________
Describe the details of the incident *
(Including names of people involved, what occurred, and what each person did and said, including specific words used).
Please use as much space as necessary.)
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(use back of paper if more space needed)
Name of Witness (person who saw the incident or have information about it):
_________________________________________________________________________________
Staff
Student
Other: _________________________
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