Harassment/bullying Investigation Form Page 2
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3Investigation Findings of Harassment/Bullying Incident
_______ The Complaint is Sustained. Bullying or Harassment was verified.
_______The Complaint was Not Sustained. There was not enough verifiable proof that Bullying
or Harassment was taking place or the complaining party has refused to assist in the
investigation.
_______ Unfounded. The complaint was discovered to have no merit or the complaining party
has informed the investigator that the allegations were false and untrue.
Reported incident has been verified as bullying according to investigation procedure and state
law definitions.
Gesture, written, or verbal expression
Verbal fight
Written or verbal threat
Written note
Written or verbal rumors
Seclusion
Embarrassing the student
Other: ____________________________
Physical Act
Physical fight
Physical injuries
Other: ____________________________
Electronic communication
Identify the component used:
Cell phone
Audio or visual image
Instant message/email
Gaming
Social Networking
Blog
Other: ____________________________
Damage of student’s property
Property damage
Stolen or missing property
Other: ____________________________
Reasonable fear of harm to person or property
Fear of harm to person
Fear of harm to property
Other: ____________________________
Disrupt or interfere with school’s educational
Changes in attendance: absences, tardies
mission or the education of student.
Missing classes/parts of school day
Changes in grades
Changes in participation of school
activities
Avoidance of elements: lunch, bus, recess
Other: ____________________________
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