7:180-AP1, E7 Response to Bullying
To be completed by the Building Principal and attached as a coversheet for the school office’s designated bullying report investigation and response folder. Place a copy of the completed coversheet only (not attachments) in each listed student’s temporary school student record. Redact all student names other than the student’s name for which the record pertains.
Initial Notices to Parents/Guardians of Involved Students:
Initial notice must be given to the parents/guardians of students involved in an incident of bullying (as well as all threats, suggestions, or instances of self=harm determined to be the result of bullying) within 24 hours of after becoming aware of the student’s involvement.
Target’s parent/guardian: ______________________________________________
Circle contact method: Phone Email Letter In-person Other: _________________
Date: ________________________________________________ Time: _____________________________________
Staff Member: ______________________________________ Title: _______________________________________
Aggressor’s parent/guardian: _______________________________________________________
Circle contact method: Phone Email Letter In-person Other: _________________
Date: ________________________________________________ Time: _____________________________________
Staff Member: ______________________________________ Title: _______________________________________
Investigator: _________________________________________ Title: ___________________________
Investigation
File an interview form for each party interviewed in the designated investigation and response folder.
☐ Check here to indicate that all interview forms have been properly completed and filed.
Target: _____________________________________________ Date: ___________________
Aggressor: __________________________________________ Date: ___________________
Witnesses: __________________________________________ Date: ___________________
__________________________________________ Date: ___________________
__________________________________________ Date: ___________________
Are there any prior documented incidents by the aggressor identified above? ☐ Yes ☐ No (Attach information)
If yes, have incidents involved target or target group previously? ☐ Yes ☐ No
Findings
☐ Bullying ☐ Other: __________________________________________________________
☐ Aggressor motivated by protected characteristics listed in policy 7:20, Harassment of Students Prohibited.
Bullying Investigation Response
Response and Plan for Target (Check all that apply and include descriptions.)
Contact parent/guardian: ________________________________________ Date:_______________
Circle contact method: Phone Email Letter In-person Other: _______________________
☐ Safety plan: _____________________________________________________________________
☐ Increase staff supervision: __________________________________________________________
☐ Education: _______________________________________________________________________
☐ Minimize contact with aggressor: ______________________________________________________
☐ District resources: (Student Services/IDEA/504) __________________________________________
__________________________________________
☐ Other: ___________________________________________________________________________
Target follow-up scheduled date: _________________________ Date and initial completed:__________
Parent/guardian follow-up date: ___________________________ Date and initial completed: _________
Circle contact method: Phone Email Letter In-person Other: _________________________
☐ Provide parent/guardian with copies of Board policies 2:260 and 7:180. Date: __________
Response and Plan for Aggressor (Check all that apply and include descriptions.)
Contact parent/guardian: ________________________________________ Date:_______________
Circle contact method: Phone Email Letter In-person Other: _______________________
☐ 7:190-E4, Aggressive Behavior Reporting Letter and Form sent Date: _______________
☐ Provide parent/guardian with copies of Board policies 2:260 and 7:180 Date: ______________
Restorative Responses
☐ Safety plan: ______________________________________________________________________
☐ Increase staff supervision: ___________________________________________________________
☐ Education: ________________________________________________________________________
☐ Non-District affiliated psychological services : _____________________________________________
☐ Alternative school assignment: _________________________________________________________
☐ Minimize contact with target: ___________________________________________________________
☐ District resources (Student Services/IDEA/504): ____________________________________________
☐ Other: _____________________________________________________________________________
Punitive Responses
☐ Loss of privileges: ____________________________________________________________________
☐ Detention: ___________________________________________________________________________
☐ Suspension: __________________________________________________________________________
☐ Expulsion: ____________________________________________________________________________
☐ Community agency service: _______________________________________________________________
☐ Reciprocal Reporting Act utilized: ☐ Yes ☐ No _______________________________________________
☐ Report to School Resource Officer/Law Enforcement: ____________________________________________
☐ Other: __________________________________________________________________________________
Aggressor follow-up date: __________________________________ Date and initial completed: _____________
Circle contact method: Phone Email Letter In-person Other: ________________________________
Parent/guardian follow-up date: _____________________________ Date and initial completed: _____________
Circle contact method: Phone Email Letter In-person Other: ________________________________
☐ Contact District Complaint Manager: ________________________ Date: _____________________________
☐ Target response implementation: ______________________________________________________________
☐ Aggressor response implementation: ___________________________________________________________
☐ Systemic culture/climate intervention: ___________________________________________________________
☐ Referral to address needs for ideal conditions for developmental learning: _______________________
☐ Other: _____________________________________________________________________________________
Submit reports to: ☐ Building Principal (if not the investigator) Date: ___________________
☐ Superintendent Date: ___________________
Signature of investigator: ______________________________________ Date: ____________________________
Date Adopted: March 21, 2023
Date Amended: September 17, 2024
