Bullying Verified ? Yes ___ No ____
Remedial Action ( s ) Taken : ___________________________________________________________ __________________________________________________________________
____________________ __________________________________________________________________
____________________
If Bullying Verified , Has Notification Been Made to Parents of Students Involved ?
Parents ’ Names : _____________________________ Parents ’ Names : _____________________________ Parents ’ Names : _____________________________ Parents ’ Names : _____________________________
Date Sent : ______________ Date Sent : ______________ Date Sent : ______________ Date Sent : ______________
If Bullying Verified , Have Invitation to Meetings Been Sent to Parents of Students Involved ?
Parents ’ Names : _____________________________ Parents ’ Names : _____________________________ Parents ’ Names : _____________________________ Parents ’ Names : ____________________________\\_
Date Sent : ______________ Date Sent : ______________ Date Sent : ______________ Date Sent : ______________
Date of Meetings :______________________________
If Bullying Verified , Has School Developed Student Safety Support / Intervention Plan ?
Y N
Name of Investigator : ___________________________
Date : ____
( Attach bullying complaint and witness statements . If bullying is verified , attach notification to parents of students involved , invitations to parent meetings , and records of parent meetings )
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