Incident Report Form (Page 2 of 5) in pdf

Incident Report Form Page 2

PREVENTING WORKPLACE BULLYING

INCIDENT REPORT FORM.

Section 1

Your Details

Name:

School:

Preferred e-mail Contact Address:

Preferred Telephone Contact:

Date of Report:

Section 2

Source of the Bullying

Please tick appropriate box or boxes

Principal

Parish Priest

Board Member

Deputy Principal

Year Level Co-ordinator

KLA Director or Department Head

Bursar or Business Manager

Staff Member

Other

If the source of the bullying is outside of the workplace please provide further

details.

Section 3

Unreasonable Behaviour

Behaviour that a reasonable person would expect to victimise, humiliate,

undermine or threaten another person. Please report the type of behaviour

you are experiencing, tick as many boxes as required.

Verbal Abuse

Intimidation

Being assigned meaningless tasks not related to your job

Being excluded or isolated from colleagues

Being given tasks which are impossible to complete

Being subjected to deliberate changes in rosters

Not being given information vital to effective work performance

Psychological harassment

Personal possessions being removed or disappearing

Other – Please provide further details

Incident Report Form Page 2