ENFIELD PUBLIC SCHOOLS REPORT OF BULLYING FORM / INVESTIGATION SUMMARY
For Staff Use Only : School _____________________________________ Date __________________
Location ( s ) __________________________________________________________________ _
Reporter Information :
Anonymous student report _____ Staff Member report _____ Name ________________________ Parent / Guardian report _____ Name ________________________ Student report _____ Name ________________________
Student Reported as Committing Act : _________________________________________ Student Reported as Victim : ___________________________________________________
Description of Alleged Act ( s ): ___________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________
Time and Place : _________________________________________________________________
Names of Potential Witnesses : _____________________________________________________________________
Action of Reporter : ________________________________________________________________________
Administrative Investigation Notes ( use separate sheet if necessary ): _____________________________________________________________________
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