BGS Bullying Reporting Question Title * 1. Please provide todays date Date / Time Date OK Question Title * 2. I am a .... The Parent/Carer of the student being bullied The student being bullied Adult friend of the student being bullied School Friend of the student being bullied Other (please specify) OK Question Title * 3. My Name is OK Question Title * 4. The student being bullied is OK Question Title * 5. I know who is bullying them Yes No OK Question Title * 6. When did this incident occur? Date / Time Date Time AM/PM - AM PM OK Question Title * 7. The Name(s) of the bully is OK Question Title * 8. Please describe what happened OK Question Title * 9. Please provide contact information if you wish us to speak to you about this incident Email Address Phone Number OK Question Title * 10. The type of bullying is (select all that apply) Verbal Physical Sexual Online/Social Media Racial Homophobic Excluding student from peer group Threats/Intimidation Stealing Property Texting/Mobile Phone Other (please specify) OK DONE
