Bullying Verified?
Yes ___
No ____
Remedial Action(s) Taken:
___________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
If Bullying Verified, Has Notification Been Made to Parents of Students Involved?
Parents’
Parents’
Parents’
Parents’
Names:
Names:
Names:
Names:
_____________________________
_____________________________
_____________________________
_____________________________
Date
Date
Date
Date
Sent:
Sent:
Sent:
Sent:
______________
______________
______________
______________
If Bullying Verified, Have Invitation to Meetings Been Sent to Parents of Students
Involved?
Parents’
Parents’
Parents’
Parents’
Names:
Names:
Names:
Names:
_____________________________
_____________________________
_____________________________
_____________________________
Date
Date
Date
Date
Sent:
Sent:
Sent:
Sent:
______________
______________
______________
______________
Date of Meetings:
_______________________________
_______________________________
If Bullying Verified, Has School Developed Student Safety Support/Intervention
Plan?
Y
N
Name of Investigator: _________________________________ Date: ________________
(Attach bullying complaint and witness statements. If bullying is verified, attach
notification to parents of students involved, invitations to parent meetings, and records of
parent meetings).
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