Does what happened fit all three parts of bullying?
1. It is repeated?
2. There is an imbalance of power.
3. The person is being mean on purpose and wants to do harm.
Name of targeted student:
What was happening before the problem?
When did it happen?
Where did it happen? Bus Playground Hallway Bathroom Cafeteria Classroom
Who was bullying?
Was an adult told?
If so, who was told?
What did the adult say the student should do?
Did the student do what the adult said? * Yes No
If so, did it help? * Yes No
Names of others who saw this happening: