HIB 338 Form: Families and Caregivers

 
 
  

HIB 338 Form
Harassment, Intimidation, or Bullying (HIB) Reporting Form
2022-23 School Year

To Be Completed by Families / Caregivers

This form should be used by parents or guardians to report allegations of HIB. Once the form is received by the school, the principal is responsible for implementing the school district’s policy and procedures. An investigation shall be completed as soon as possible, but not later than 10 school days from the date of the written report of the incident. Should you have any questions about the investigation, please contact the school principal.

Directions

Complete the form below to provide detailed information of the alleged HIB incident. If some fields are not applicable or if you are uncertain of the response, you may skip those fields. This form may be submitted anonymously.


 

 
 

Individual Completing Form

If you prefer to remain anonymous, leave this section blank.


   
 
 
   
 
 
   
 
 
   
 
 
   

 
 

Incident Information


   
 
*
  Select Date
mm/dd/yyyy
   
 
 
   
 
*
 
   
 
 
   

 
 

Alleged Offender(s)


   
 
 
   
 
Select at least 0 and no more than 0.
 
  
  
  
  
   

 
 

Alleged Victim(s)


   
 
 
   
 
Select at least 0 and no more than 0.
 
  
  
   

 
 

Witnesses

Complete this section with the names of any potential witnesses


   
 
 
   
 
 
   
 
 
   
 
 
   
 
 
 
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