ENFIELD PUBLIC SCHOOLS
FORM C
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 ________________________
report _____ Name ________________________
Student
Student Reported as Committing Act: _________________________________________
Student Reported as Victim: ___________________________________________________
Description of Alleged Act(s): ___________________________________________________
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Time and Place: _________________________________________________________________
Names of Potential Witnesses: __________________________________________________
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Action of Reporter: _________________________________________________________________
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Administrative Investigation Notes (use separate sheet if necessary):
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