Coakley Middle School Anonymous Bullying Report
"Anonymous" means that no one will know you made this report unless YOU tell them! This report is CONFIDENTIAL! You will not be asked to give your name or any information that would identify you as the reporter. Your report will be taken seriously and investigated by school personnel.
What date did the bullying incident occur?
Who is the target/victim of the bullying incident? Please give first and last name.
Name of the alleged aggressor/offender(s) of the bullying incident. Please give first and last name(s).
Where did the incident happen? (Check all that apply.)
On school property
At a school sponsored activity
At the bus stop
On a school bus
On the way to/from school
On computer/cellphone or other electronic device
Put a check next to all the statement(s) that best describe(s) what happened.
What did the alleged aggressor/offender say or do?
Did a physical injury result from this incident?
Yes - If yes, please explain
Did the injury require medical attention?
Yes - If yes, please explain below
Was the target/victim absent from school as a result of this incident?
If yes, how many days?
Please indicate how you know about the incident:
I witnessed it
I heard about it
Do Not Fill This Out