Report Bullying

Ocean Township Intermediate School
Anti-Bullying Specialist is Elyssa Green, Student Assistance Counselor

Stop Bullying

HIB 338 Form

Harassment, Intimidation, or Bullying (HIB) Reporting Form

2023-2024 School Year

To Be Completed by Families / Caregivers

 

This form should be used by parents or guardians to report allegations of HIB. A written statement from the alleged victim or other evidence may be sent to the Anti-Bullying Specialist listed above. 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.

School Information:


School District 

School 

Individual Completing Form:


If you prefer to remain anonymous, leave this section blank. Individuals filling out this HIB 338 Form as an anonymous reporter may consider adding their name as a witness. AND Complete this section with the names of any potential witnesses.

Name of individual completing this form 

Relation to individual involved in alleged incident of HIB (e.g., parent, guardian, grandparent, etc.) 

Phone number 

Email address 

Incident Information:


Incident date (mm/dd/yyyy) 

Approximate time of the incident 

Describe the incident with as much detail as possible. (What was the incident? Who was involved in the incident? How you were made aware of the incident? What happened at the time of the incident? How did the incident occur?)

Specific incident location(s) (e.g., on the morning school bus, in the science wing hallway, online via social media, etc.)

Alleged Offender(s):


Name(s) of alleged offender(s): 

Based on your knowledge, select all that apply about the alleged offender(s):

 Alleged offender(s) attends the above-named school.

 Alleged offender(s) attends another school.

 Alleged offender(s) works for the school/school district.

 Alleged offender(s) does not work for the school/school district.

Alleged Victim(s):


Name(s) of alleged victim(s): 

Based on your knowledge, select all that apply about the alleged victim(s):

 Victim(s) attends the above-named school.

 Victim(s) attends another school.

Witnesses:


Complete this section with the names of any potential witnesses.

Student Names:

Staff Names:

Parent Names:

Other Names (specify title or position for each): 

Signature:


Signature of Person Completing this HIB 338 Form 

Date 



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