Handbook for 2022-23 School Year Elementary Handbook for 2022-23 School Year | Page 28

Enfield Public Schools Report of Bullying / Teen Dating Violence Form / Investigation Summary

5131.911 Form 1

School Date

Location ( s )

Reporter Information :

Anonymous student report Staff Member report Parent / guardian report Student report

Name Name Name

Student Reported as Committing Act :

Student Reported as Victim :

Description of Alleged Act ( s ):

Time and Place :

Names of Potential Witnesses :

For Staff Use Only :

Action of Reporter :

Administrative Investigation Notes ( use separate sheet if necessary ):

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