QJHS Online Bullying Form
What is today's date?
What type of bullying is happening?
Being called names
Being spit on
Being sent mean emails or text messages
Having bad jokes or stories told about you
Having something of yours taken from you
Having been excluded from a group
Having notes written about you
Being forced to do something you do not want to do
Being pushed or hit
Other (please explain in box below)
If you chose "other" from above, please explain here:
Where is the bullying occurring?
Who is it happening to? (Who is the victim?)
Who is doing the bullying?
Please describe what has happened in your own words?
Have you witnessed the bullying occur?