FORM C
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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