Harassment, Intimidation & Bullying Investigation Report Form
Copies of this form, all documents, notes and letters should be sent to
HIB Compliance Officer, Dani Mundell, Athletics Department

Today’s date:

Harassment, Intimidation & Bullying Investigation Report Form

The purpose of this form is to gather data on reported HIB complaint.

Date complaint received: Date(s) of incident(s):

School: Investigator’s name:

Complainant name:

Alleged aggressor(s) name:

Was a HIB complaint form submitted? Yes No

If yes, in what form? Safe Schools Paper Other (specify: )

Was an investigation conducted? Yes No

If no, explain:

1. Briefly describe incident(s); (incl location of incident, any injuries or property damage)

2. Persons interviewed:

3. Witnesses (if any):

4. Documents/evidence reviewed:

5. What outside agencies contacted, if any? (ie police, tribal, religious, other)

6. This incident was: Bullying Harassment Other Not HIB

7. Explain findings/conclusion:

8. Action taken:

9. Is the issue resolved? Yes No (explain: )

Copies of this form, all documents, notes and letters should be sent to

HIB Compliance Officer, Dani Mundell, Athletics Department