HIB 338 Form

Harassment, Intimidation, or Bullying (HIB) Reporting Form
2022-23 School Year To Be Completed by Families / Caregivers

This form should be used by parents or guardians to report allegations of HIB. Once the form is received by the school, the principal is responsible for implementing the school district’s policy and procedures. An investigation shall be completed as soon as possible, but not later than 10 school days from the date of the written report of the incident. Should you have any questions about the investigation, please contact the school principal.

"*" indicates required fields

Directions

Complete the form below to provide detailed information of the alleged HIB incident. If some fields are not applicable or if you are uncertain of the response, you may skip those fields. This form may be submitted anonymously.

School Information

Individual Completing Form

If you prefer to remain anonymous, leave this section blank.
Name of Individual Completing this form:

Incident Information

Incident Date:*
Approximate time of the incident
:

Alleged Offender(s)

Based on your knowledge, select all that apply about the alleged offender(s):

Alleged Victim(s)

Based on your knowledge, select all that apply about the alleged victim(s):

Witnesses

Complete this section with the names of any potential witnesses.
This field is for validation purposes and should be left unchanged.