- Everett Public Schools
Harassment, Intimidation or Bullying (HIB) Incident Reporting Form
Today’s date:
Reporting person (optional):
Targeted student:
Targeted student’s school:
Your email address (optional):
Your phone number (optional):
Name of school adult you’ve already contacted (if any):
Name(s) of bullies (if known):
List dates when incidents occurred (if known):
Where did the incident happen? Putting the student down and making the student a target of jokes
Making rude and/or threatening gestures
Excluding or rejecting the student
Making the student fearful, demanding money or exploiting
Spreading harmful rumors or gossip
Cyber ...
EPS HIB Incident Reporting Form 
